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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
Wed Oct 24 2018
Journal Name
Chemistry Of Materials
Oxidant or Catalyst for Oxidation? A Study of How Structure and Disorder Change the Selectivity for Direct versus Catalytic Oxidation Mediated by Manganese(III,IV) Oxides
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Structure type and disorder have become important questions in catalyst design, with the most active catalysts often noted to be “disordered” or “amorphous” in nature. To quantify the effects of disorder and structure type systematically, a test set of manganese(III,IV) oxides was developed and their reactivity as oxidants and catalysts tested against three substrates: methylene blue, hydrogen peroxide, and water. We find that disorder destabilizes the materialsthermodynamically, making them stronger chemical oxidantsbut not necessarily better catalysts. For the disproportionation of H2O2 and the oxidative decomposition of methylene blue, MnOx-mediated direct oxidation competes with catalytically mediated oxidation, making the most

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Publication Date
Fri Aug 27 2021
Journal Name
Journal Of Craniofacial Surgery
The Effects of Local Alendronate With or Without Recombinant Human Bone Morphogenetic Protein 2 on Dental Implant Stability and Marginal Bone Level: A Randomized Controlled Study
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The aim of this study was to evaluate the effects of local application of bisphosphonate gel and recombinant human bone morphogenic protein 2 gel, on titanium dental implant stability and marginal bone level. Twenty-seven patients with upper and lower missing posterior tooth/teeth were included in the study with a total of 71 implants that were used for rehabilitation. The implants were randomly divided into 4 groups: 3 study groups and 1 control. Group1; local application of bisphosphonate gel, group 2; local application of recombinant human bone morphogenic protein 2 gel, group 3; local application of a mixed formula of both gels. The gel application was immediately preimplant insertion, group 4; implant insertion without application of a

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Publication Date
Tue Dec 22 2020
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Accounting Disclosure for non-current intangible assets according to international accounting standard (IAS16, 36): A Comparative Study of the State Company for Travelers and delegates Transportations
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The Accounting Disclosure for non-current intangible assets is necessary to rely on accounting information by decision makers in the economic unity, two international accounting standards issued (IAS16,36), which aims to provide the foundations of the recognition, measurement and disclosure of appropriate assets Non-current tangible. (IAS16) allowed to use re-evaluation approach to measure assets entrance due to the inadequacy of the accounting information resulting from the application of the historical cost of the entrance under increasing technical developments and continuing that leave clear their effects on non-current intangible assets, As well as the requirements of what came (IAS36) the importance of accounting for the impairment

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Publication Date
Fri Dec 01 2017
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The impact of multiple sources of funding on the disclosure of cash flow and the activation of control procedures
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The principle of an interview requires revenues to expenditures by linking the efforts and achievements and disclosure sufficient to result activity, in the case generate future benefits of a particular asset, this asset appears in the balance sheet to reflect with the rest of the accounting unit's assets on the strength of financial position In the absence of future benefits from the effort are so loaded effort on the result accounts that reflect the outcome of activity during a specific period if the month or be separated or fiscal year. 

The researcher reached the following conclusions:

 1- difficult to control the cash inflows and outflows as a result of the multiplicity of sources of funding.

2- wea

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Publication Date
Thu Feb 13 2020
Journal Name
Energies
Impact of the Type of Fertilization and the Addition of Glycerol on the Quality of Spring Rape Straw Pellets
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This paper presents an analysis of selected qualitative characteristics of pellets produced from rape straw obtained from cultivations subjected to different fertilization treatments and from mixtures of straw selected for testing with crude glycerol obtained as a by-product from biodiesel production. The assessment focused on the following qualities of the obtained pellets: Moisture content, mechanical durability, heating value and main elements, that is, carbon, hydrogen, nitrogen, sulphur, chlorine and oxygen. The obtained results indicated that the different treatment regimens applied in spring rape cultivations had a significant impact on the physicochemical qualities of the straw. In terms of the heating value, traditional fer

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Publication Date
Tue Jul 01 2025
Journal Name
Journal Of Studies In Humanities And Educational Sciences
The Effect of the Needham Constructivist Model on the Achievement of Third Year Biology Department Students in the Subject of Teaching Methods
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The current research aims to know the effect of Needham's constructivist model on the achievement of third-year students in the Life Sciences Department in the teaching methods subject. To achieve the research objectives, the experimental method was followed for the experimental and control groups with dimensional measurement of the achievement variable of the teaching methods subject. The research sample included (62) students in the third year of the Life Sciences Department, distributed into two equal groups in the variables (self-assessment of learning methods - chronological age in years - intelligence level - previous information). To measure the level of students' achievement, an achievement test was constructed consisting of (40) te

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Publication Date
Sat Jun 17 2023
Journal Name
Journal Of Namibian Studies - History Politics Culture
The Effect Of Productive Thinking Strategy Upon The Student’s Achievement For The Subject Of Research Methodology In The College Of Islamic Sciences
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The aim of this paper is to find out the effects of the strategy of productive thinking upon the student’s achievement for the subject of research methodology in the College of Islamic Sciences. Achieving this objective, the researchers set the null hypotheses: (1) No difference is noticed to be statistically significant at the level of significance (0.05) among the student’s mean scores in the experimental group who were taught by the strategy of productive thinking, and the student’s mean scores in the control group who studied by the traditional method in the achievement test. (2) At level of sig. (0.05), there is no statistically significant difference in the mean of scores of the pre-tests and post ones in the achievement test of

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Publication Date
Sun Jan 01 2023
Journal Name
Journal Of Namibian Studies,
The Effect Of Productive Thinking Strategy Upon The Student’s Achievement For The Subject Of Research Methodology In The College Of Islamic Sciences
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The aim of this paper is to find out the effects of the strategy of productive thinking upon the student’s achievement for the subject of research methodology in the College of Islamic Sciences. Achieving this objective, the researchers set the null hypotheses: (1) No difference is noticed to be statistically significant at the level of significance (0.05) among the student’s mean scores in the experimental group who were taught by the strategy of productive thinking, and the student’s mean scores in the control group who studied by the traditional method in the achievement test. (2) At level of sig. (0.05), there is no statistically significant difference in the mean of scores of the pre-tests and post ones in the achievement test of

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Publication Date
Tue Sep 15 2020
Journal Name
Al-academy
The Impact of Elements of the Ancient Iraqi Heritage in the Gallery of the Iraqi Natural History Museum: محمود حسين عبد الرحمن
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  The research addresses the most important elements of the ancient Iraqi heritage represented by architecture and plastic arts being the direct means that preserved the heritage due to the ease of preserving them and the speed of circulating them and diversity of their topics. Through the features of these elements, the research problem has been defined in the form of questions including: what are the most important elements of the ancient Iraqi heritage? What are the plastic arts? What are the most important topics adopted? What is the concept of palm in the ancient Iraqi heritage? What is the evidence for that?
Has it been employed in the Iraqi contemporary art? What is the evidence for that? How to employ it in the arts and t

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Publication Date
Mon Aug 01 2016
Journal Name
Journal Of Economics And Administrative Sciences
The Development of the Suez Canal and Projects Competitors
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The area around the Suez Canal has been chosen particularly  Sinai  to implement the new Suez Canal project parallel to the original 72-km-long channel due to the importance of the commercial site of the Arab Republic of Egypt, competing with shipping lanes, to accommodate the increasing maritime traffic  passing through the Suez canal, and to provide special services for trade world and reduce the economic cost of marine trip. The establishment of six tunnels for automobile and railway transport to Sinai The cost of the establishment of this new channel  and the establishment of the tunnels about (2.8) billion, of which 4 billion cost of the new channel. Project implementation period is one year. The new proj

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