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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
Tue Jul 30 2024
Journal Name
Iraqi Journal Of Science
The Influence of Sucrose on Biomass and Glycosides Content of Callus Cultured from the Leaves of Stevia rebaudiana Berton
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Stevia rebaudiana Bertoni contains diterpenoid steviol glycosides that have no adverse impact on blood sugar levels despite being 300 times sweeter than sugar. This study aimed to investigate the rate of callus induction from stevia leaves and the content of glycosides when changing the sucrose percentage in the culture medium.. Murashige and Skoog (MS) culture medium supported by 4.0 mg/l naphthalene acetic acid (NAA) and 1.0 mg/l benzyl adenine (BA) was used, and different concentrations of sucrose (2, 3, 4, 5 and 6%) were tested .The extraction of glycosides from leaf and callus tissues was performed by using methanol. Extracted glycosides were analyzed by high-performance liquid chromatography (HPLC). The results showed signific

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Publication Date
Sun May 22 2022
Journal Name
International Journal Of Early Childhood Special Education (int-jecs)
The image of Al-Shuhada'a Establishment among the families of martyrs, victims of terrorism, war operations and military mistakes
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This research (The families of martyrs, victims of terrorism, war operations and military mistakes opinion about Al- Shuhada`a Establishment ) came to know and diagnose the mental image the martyrs victims of terrorism carries about the performance of Al- Shuhada`a Establishment and the services it provides to them, and to monitor the contents of that image that they had regarding their privileges and rights that Al- Shuhada`a Establishment supposed to give it to them, according to their law. The research problem was represented by the main question: (What is the image of Al- Shuhada`a Establishment among the families of martyrs, victims of terrorism, war operations and military mistakes), and this research was classified within the d

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Publication Date
Tue Sep 01 2009
Journal Name
Journal Of Economics And Administrative Sciences
Comparison of estimation methods for regression model parametersIn the case of the problem of linear multiplicity and abnormal values
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 A simulation study is used to examine the robustness of some estimators on a multiple linear regression model with problems of multicollinearity and non-normal errors, the Ordinary least Squares (LS) ,Ridge Regression, Ridge Least Absolute Value (RLAV), Weighted Ridge (WRID), MM and a robust ridge regression estimator MM estimator, which denoted as RMM this is the modification of the Ridge regression by incorporating robust MM estimator . finialy, we show that RMM is the best among the other estimators

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Publication Date
Sat Oct 01 2011
Journal Name
Journal Of Baghdad College Of Dentistry
Effect of etchant type and the use of silane on the shear bond strength of composite resin to porcelain
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Background: This study was formulated to compare the effect of 5%hydrofluoric acid in comparison to 37%phosphoric acid with and without the application of silane on bond strength of composite to porcelain. Materials and Methods: Specimen preparation was divided in to two phases, metal-disks fabrication (8mm-diameter and 4mm-thickness) and ceramic veneering. Thirty two specimens were prepared, sandblasted with 50 μm aluminum oxide, and divided into four groups of eight samples. Groups I and III were etched with 37%phosphoric acid while groups II and IV were etched with 5%hydrofluoric acid; and groups I and II were silaneted while groups III and IV were not. Heliobond, and resin composite were applied to each specimen using a plastic transpa

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Publication Date
Sun Mar 01 2020
Journal Name
Baghdad Science Journal
The Effect of Alcoholic and Aqueous Extract of Piper nigrum on the Larvae of Culex pipiens molestus Forskal (Diptera:Culicidae)
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          The present study includes the effect of the ethanolic and aqueous extract of Piper nigrum against the third instar of Culex pipiens molestus (Diptera:Culicidae) in different concentrations: 1, 1.5 ppm of ethanolic extracts of Piper nigrum causing 100% mortality of larvae in the second day of treatment, while the concentrations 5% of aqueous extracts of Piper nigrum caused 100% mortality of larvae in the second day of treatment. The concentration 2.5% caused 100% mortality of larvae after four days of treatment. The current study also detected the effect of 0.1% concentration of Piper nigrum aqueous extract. The effect of this concentratio

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Publication Date
Tue Dec 13 2011
Journal Name
Iraqi Journal Of Laser
The Effect of 532nm Nd: YAG Pulsed Laser on the Activity of Superoxide dismutase and Alcoholdehydrogenase of Saccharomyces Cerevisiae
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In this study, the effect of Nd: YAG laser on the activity of superoxide dismutase (SOD) and alcoholdehydrogenase (ADH) was investigated. The Saccharomyces cells were irradiated using 532nm Q-Switched Nd: YAG laser with (1Hz) frequency. Different fluences 11.3, 22.6 and 33.9mJ/cm2 and different number of pulses 15, 30 and 60 pulse were used. The irradiated cells were incubated in a liquid nutritive medium for 24 hours. After incubation, the cells were harvested and disrupted to extract the intracellular enzymes and their activities were assessed. In comparison with the control, the irradiated cells showed a significant increase in the activity and the specific activity of SOD at energy densities of 11.3 and 22.6mJ/cm2 at 30 and 60 pulses

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Publication Date
Wed Dec 22 2021
Journal Name
Polymers
Modifications of Polymers through the Addition of Ultraviolet Absorbers to Reduce the Aging Effect of Accelerated and Natural Irradiation
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The photooxidative degradation process of plastics caused by ultraviolet irradiation leads to bond breaking, crosslinking, the elimination of volatiles, formation of free radicals, and decreases in weight and molecular weight. Photodegradation deteriorates both the mechanical and physical properties of plastics and affects their predicted life use, in particular for applications in harsh environments. Plastics have many benefits, while on the other hand, they have numerous disadvantages, such as photodegradation and photooxidation in harsh environments and the release of toxic substances due to the leaching of some components, which have a negative effect on living organisms. Therefore, attention is paid to the design and use of saf

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Publication Date
Wed Jan 30 2008
Journal Name
College Of Islamic Sciences
The judiciary in Jerusalem in the Islamic era
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God created man with a social nature, that is, man cannot live alone, but there must be a society associated with him. And when God addressed Adam, the first of His creation, he addressed him with the speech of the Muthanna to him and his wife. “This tree, then you will be among the wrongdoers” (Al-Baqara: 35), and thus was the divine discourse for the first human experience on earth. It accommodates a social relationship, which is (the family), husband and wife. And since a person needs to meet, as Ibn Khaldun said: (The human meeting is necessary, and the wise men express this by saying (the human being is of course civil)) (). And as it is known that with the meeting, relations arise from love and hate, cooperation and struggle, a

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Publication Date
Tue Feb 05 2019
Journal Name
Journal Of The College Of Education For Women
Variation of the Labor Force Distribution according to the Economic Activity of the Population of Anbar Province for the Period 1987 – 2011
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This study deals with the Spatial and Periodical Variation of the Economical Activities for the
Population of Al – Anbar Province on the level of districts , according to the Population
Computation for the period 1987 and 1997 and the results of determinations and numberings
for the year of 2011 .
This study depends on the Details Classifications of the 17th Activities for 1997 and 2011
beside the Triple Classification of the Economical Activities for the three study years .
The study proves that there is a spatial and periodical variation on the level of study area , and
that’s because of many factors , one of the most important of them was the distribution of
economical siege, as well as the weakness of the

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Publication Date
Thu Jun 30 2016
Journal Name
Iraqi Journal Of Chemical And Petroleum Engineering
Determination of the Optimum Conditions for the Production of Gamma Alumina (ɤ-Al2O3) By the Precipitation Method of the Sodium Aluminate Solution
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Design of experiments (DOE) was made by Minitab software for the study of three factors used in the precipitation process of the Sodium Aluminate solution prepared from digestion of α-Al2O3  to determine the optimum conditions to a produce Boehmite which is used in production of ɤ-Al2O3 during drying and calcination processes, the factors are; the temperature of the sodium aluminate solution, concentration of HCl acid added for the precipitation and the pH of the solution at which the precipitation was ended. The design of the experiments leads to 18 experiments.

   The results show that the optimum conditions for the precipitation of the sodium aluminate solution which

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