Print ISSN: 2790-0207

Online ISSN: 2790-0215

Main Subjects : General Surgery


Treatment of recurrent pilonidal sinus by flap technique (Limberg flap )

abdulkareem omer Mohamed salih

Kirkuk Journal of Medical Sciences, In Press

Background: pilonidal sinus(PNS) is a chronic disease that mostly affects young adults. describes a hair-filled cavity in the subcutaneous fat of the post sacral intergluteal region, known as the natal cleft , its name arises from the Latin terms “pilus” and “nidus” meaning a nest of hair PNS can be asymptomatic, or may be present as a recurrent abscess or as chronic inflamed cavity and local discharge from sinus or sinuses and local pain and discomfort .
retrospective study was done from (November 2017 to November 2018) at surgical department in Kirkuk General Hospital in 50 patients with recurrent PNS all will be treated with Limberg flap then follow up for one year this surgery done by excision of PNS till we reach fascia overlying sacrum inferiorly and laterally till we reach gluteal fascia and dissection was performed with electro cautery and reconstruction done by flap (Limberg flap) from gluteal area
in 50 patient with recurrent PNS we have 45 (90%) were male and 5 (10%) were female ,30 patient (60%) patients had a familial history of PNS and 42 patients(84%) with etiology-related risk factors to develop PNS then we divided them according first time surgery done either, by excision and primary closure 30 patient(60%) or excision and healing by granulation tissue and secondary intension 20patient (40%)

Sacroiliac joint dysfunction is one of an important cause of low back pain

Mukaram Noor Alddin Musarhad

Kirkuk Journal of Medical Sciences, 2021, Volume 9, Issue 2, Pages 27-35
DOI: 10.32894/kjms.2021.171290

Objective: This prospective study about importance to consider Sacroiliac joint ( SIJ ) dysfunction as one of important cause of low back pain and estimation the occurrence of SIJ dysfunction in low back pain.
Background: The SIJ is formed by the articular surfaces between the sacral and iliac bones.The joint dysfunction with slightly joint subluxation, which are majority of SIJ disorders. Establishing the diagnosis of SIJ pain are difficult because history, clinical examination and imaging studies are not helpful in confirming the diagnosis.
Patient and Method: fifty patients participated through eighteen months period from October 2017 to March 2019 estimated occurrence SIJ dysfunction in low back pain below L5 group Patients with low back pain and have three or more positive provocative SIJ tests on physical examination these patients candidate diagnostic injection of local lidocaine into the SIJ, patient pain improve more than 70% in his or her pain within 30 to 60 minutes and diagnosis of SIJD confirmed.
Results:Our prospective study included fifty patients, the 20% of LBP group have SIJ dysfunction, more prevalence in obese patients, among female gender.SIJ dysfunction more common on left side 70%, right side in 30%.
Conclusion:Sacroiliac joint dysfunction remarkably missed underestimated cause of low back pain.The prevalence of SIJ dysfunction are15% to 30% of LBP in many studies.High suspicion and accurately diagnosis required of SIJ dysfunction to be cost effective in management of patients with low back pain and avoid unnecessary lumbosacral spine surgical interventions and decrease failed back surgery syndrome (FBSS) incidence.

The role of plasma ammonia level in detecting intra-abdominal hemorrhage following blunt abdominal trauma

Hussein Hussein Kasim

Kirkuk Journal of Medical Sciences, 2021, Volume 9, Issue 2, Pages 10-26
DOI: 10.32894/kjms.2021.171639

Background:
Blunt abdominal injury is a major cause of death in trauma cases. It will be very helpful if intra-abdominal bleeding can be predicted by laboratory tests. The aim of our study is to evaluate the accuracy of plasma ammonia in detecting intra-abdominal hemorrhage in patients with blunt abdominal injury.
Materials and Methods:
In this study, 60 patients admitted to Azadi teaching hospital complaining from blunt abdominal trauma were included. On admission to emergency room, plasma ammonia levels were measured. Demographic data, vital signs, and GCS reports were written down. Findings of abdomino-pelvic computed tomography scan and intraoperative laparotomy were supposed as a gold standard for abdominal injuries. We excluded patients with preexisting liver diseases or impairment.
Results:
In this study 60 patients were involved. 6 patients had intra-abdominal bleeding and their mean plasma ammonia level was much higher than the rest. (205.33±100.2 vs. 51.29±23.38, P < 0.001). ROC curve analysis revealed Accuracy 96.7% Sensitivity 83.3% Specificity 98.1%.
Conclusion:
The study results advocate that an increase in plasma ammonia level in patients with blunt abdominal trauma would be a useful predictor for intra-abdominal hemorrhage. This can be a great opportunity for hospitals lacking advanced facilities like contrast enhanced CT scan or diagnostic laparoscopy.

A comparative study betwee Medulloblastoma And Cerebellar astrocytoma In children

Salim Aljabbary

Kirkuk Journal of Medical Sciences, 2021, Volume 9, Issue 2, Pages 97-110
DOI: 10.32894/kjms.2021.172831

study was conducted between 2000 & 2002, 50 children with histopathologyically verified medulloblastoma and cerebellar astrocytoma in neurosurgical department of Surgical Specialties Hospital. Ages ranged from 2-19 years, peak incidence between 5-10 years. No significant gender differences found.

CT scan confirmed features of medulloblastoma: midline location, well defined margin & hyperdensity of lesion with homogenous enhancement after I.V. contrast infusion. In cerebellar astrocytoma, 60% were midline tumor, most of which were solid & 40% were hemispheric lesion, most of which were cystic. Calcification on CT scans seen more in medulloblastoma.
Shunt operation was the main procedure conducted for treatment of hydrocephalus associated with these tumors, but other CSF diversion procedures, especially safety burrhole at time of tumor resection was carried on in cystic lesion located off the midline. Total removal was achieved in 46.7% of children with medulloblastomas & 50% of children with cerebellar astrocytomas. Brain stem violation was evident more in medulloblastoma & was the main factor behind the incomplete tumor removal in significant number of cases that adversely affected the outcome.
postoperative complications (pseudomeningocele, cerebellar mutism, meningitis, CSF leak, cranial nerve palsy…etc.) encountered more in children with medulloblastoma.
Mortality rate was 6.7% in medulloblastomas & 10% in cerebellar astrocytoma. The cause of death in patients with medulloblastoma was meningitis & patients with cerebellar astrocytomas was brain stem injury.
early diagnosis & total removal of tumor with proper postoperative care would essentially decrease the postoperative morbidity & mortality