Background: Laparoscopic cholecystectomy has many difficulties which include port Insertion, Dissectionof the Calot’s Triangle , Grasping of the Gallbladder , Wall thickness, Adhesion and extraction of theGallbladder. Aim of the Study: To predict how difficult cholecystectomy will be from assessing the patientpreoperatively which, in turn, help in decreasing the risks on the patients and preventing post-operativecomplications. Patients and Methods: A prospective study conducted in the department of General Surgeryat Al-Ramadi Teaching Hospital for the period of nine months from 15th of May 2018 till the 15th of February2019. It included 60 patients, all of them were undergone laparoscopic cholecystectomy for Gallstone. Patientswith common bile duct calculus, dilated common bile duct, current attack of acute cholecystitis, those withabsolute contraindications to laparoscopic cholecystectomy, The data were collected prospectively to predictthe significance of association with patients’ characteristics. The time of operation was calculated from thefirst port site incision until the last port closure. All the intra operative events were recorded. Conversionsto open cholecystectomy were done by median or subcostal laparotomy according to the surgeon’s decisionand each patient’s condition. Results: In this study, the highest proportion of operations was categorizedas easy (58.3%), 28.3% of operations were considered difficult and 13.3% of them were very difficult. Asignificant association (P < 0.05) between operation difficulty and all of the following characteristics: Aging,obesity, history of previous biliary hospitalization, thickened bladder wall, pericholecystic collection, andlarge stones. Conclusions: The difficult laparoscopic cholecystectomy can be predicted preoperativelybased on number of factors, like: obesity, previous biliary admission, gall bladder wall thickness, ultrasoundfindings (stone size and pericholecystic fluid) and aging process, evaluating of such factors minimize thecomplications of laparoscopic cholecystectomy and conversion to the open procedure.
The study examines Julia Alvarez's role as a Dominican American author, poet, and essayist. Despite being born in New York City in 1950, she was raised in the Dominican Republic by a family with Dominican heritage. Her residence in her ancestral homeland significantly influenced her subsequent literary works. Upon her father's implication in a conspiracy against Dominican President, he departed from the Dominican Republic. Alvarez encountered the challenge of the English language. They were compelled to acquire proficiency in English due to the prevailing perception that anyone who spoke a language other than English were deemed "un-American" during that period. Alvarez recounted her initial encounters in the United States and the subseque
... Show MoreThis research is a modest effort to talk about the great world of ancient lineage, Imam Majd al-Din Abu Saadat, known as Ibn al-Atheer island, through the statement of his name, surname, nickname, family, elders and his pupils and his most important works.
It also deals with the modern research on his famous book in the field of modern science called (the end in the strange talk and impact), which is one of the most wonderful books of modern and especially the strange talk, through the scientific effort of the Imam and the importance of the book and methodology, and the most prominent aspects of the service and care of Ibn Al Atheer For the modern stranger, which boils down to two aspects:
First: the linguistic rooting of the stran
The research aims to evaluate the direct deduction department’s procedures for the process of collecting income tax using the direct deduction method for state departments and the public sector in light of direct deduction tax instructions No. (1) of 2007 and Income Tax Law No. (113) of 1982 (amended) through Giving a clear idea of the reality of tax collection procedures because this type of tax is one of great importance because it contributes to the provision of financial revenues to the state to finance its expenses and direct the economy towards achieving its social, economic and political goals. The researcher makes comparisons between the procedures of the General Tax Authority in collecting the tax and what was approved b
... Show MoreLand Transport regards a main element in the In Fra – structure of the national economy where distance and time shortness, open new opportunities of work, develop the different regions and rise the standard of living….
It is necessary to emphasize that the circumastances surrounding Iraq such as wars, economic sanctions, blockade occupation effected negatively upon economic Indicators of land Transportion including Value of output Value added contraction of Investment allocation and Investment expend tuer and the period of implementation and fulfillment of the projects of Land Transport to be ready to offer their service in underdeveloped country Like Iraq aiming to satisfy Fast and acomprehensi
... Show MoreThis study aims to investigate the academic leaders’ perceptions towards the degree of availability of the dimensions of organizational immunity systems at the University of Tabuk, as well as to reveal the statistically significant differences between the average responses of the study sample members about the degree of availability of these dimensions at their university due to the variables of (gender, leadership position, and college specialization). To achieve the objectives of the study, a descriptive survey method was used. The study population consisted of (200) male and female leaders who were academic leaders at the University of Tabuk. A questionnaire was used as a tool for collecting data, which its validity and reliability
... Show MoreBackground: Strangles is a highly contagious equine respiratory disease caused by Streptococcus equi subsp. equi. It is a globally significant pathogen and one of the most common infectious agents in horses. In Iraq, no sequencing data on this pathogen are available, and only two molecular studies have been published to date. This study provides preliminary insights into strain diversity and provides a foundation for future large-scale investigations. Aim: This study aimed to investigate the molecular characteristics, identify SeM gene alleles, and perform a phylogenetic analysis of S. equi isolates from horses in Baghdad, Iraq. Methods: We analyzed 59 Streptococcus spp. isolates previously obtained from equine clinical sample
... Show MoreBackground: Ultrasonography has been used to examine the thickness of the lower uterine segment in women with previous cesarean sections in an attempt to predict the risk of scar dehiscence during subsequent pregnancy. The predictive value of such measurement has not been adequately assessed. Objectives: To correlate lower uterine segment thickness measured by trans abdominal ultrasound in pregnant women with previous cesarean section with that measured during cesarean section by caliper and to find out minimum lower uterine segment thickness indicative of integrity of the scar.Methods: A prospective observational study at Elwyia Maternity Teaching Hospital, from January 2011 to January 2012. A total of 143 women were enrolled in the stu
... Show MoreThe accession of countries to the World Trade Agreement and the openness of markets to each other without restrictions led to the emergence of the philosophy of "a world without borders and business units without countries", which required adapting the modern business environment to that philosophy, which is considered as objectives for the activities of the units that must be implemented in order to achieve competition. The objective of the units has changed from making profit to meeting the desires of customers, which is what imposed a new role for management accounting as a field of knowledge renewed in it visions of competitiveness between units. Because of the increasing needs for information in light of environmental change
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The aim of the current research is to identify the level of availability of written expression skills included in the Arabic language curriculum document among middle school students from the teachers' point of view. The researcher used the descriptive approach. To analyze the data and access the research results, he used the (SPSS) program. The research was conducted during the first semester of the academic year 1442/1443 AH on a random sample of Arabic language teachers in the Bisha Education Department. They reached about (213) male and female teachers. The results revealed a number of indicators: the level of availability of written expression skills among middle school students in Bisha governorate
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