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 main purpose of the research is to demonstrate the importance of the insurance sector in the economy through its role in providing security for all economic sectors and thus stimulating the gross domestic product and reducing dependence on the output of the oil sector, which may expose the Iraqi economy to several problems and imbalances, I have found that there is a great weakness in the role of the insurance sector in Iraq at the level of government, companies and individuals, and the reason for this is the lack of policies supporting the insurance sector and the lack of work in the strategy of economic diversity and the decrease of security awareness by individuals so became Developing the sector to ensure the urgent need
... Show MoreInternal control system is a safety valve that preserves economic units assets and ensure the accuracy of financial data, as well as to obligation in the laws, regulations, administrative policies ,and improve the efficiency, effectiveness and economic of operation, so it has become imperative for these units attention to internal and developed control system The research problem in exposure the economic units when the exercise of their business to many of the risks to growth or hinder the achievement of its objectives and the risks (financial, operational, strategy, risk) and not it rely on risk Assessment according to modern scientific methods, as in Brown's risk Classification, Which led to the weakness of the internal control identif
... Show MoreAge, hypertension, and diabetes can cause significant alterations in arterial structure and function, including changes in lumen diameter (LD), intimal-medial thickness (IMT), flow velocities, and arterial compliance. These are also considered risk markers of atherosclerosis and cerebrovascular disease. A difference between right and left carotid artery blood flow and IMT has been reported by some researchers, and a difference in the incidence of nonlacunar stroke has been reported between the right and left brain hemispheres. The aim of this study was to determine whether there are differences between the right and left common carotid arteries and internal carotid arteries in patient
Background: Chronic kidney disease is a gradual loss of kidney function with diabetes and hypertension as the leading cause. Chronic kidney disease is one of these systemic diseases that can affect salivary contents. Aims: This study aimed to assess salivary immunoglobulin A, interleukin-6 and C- reactive protein in chronic kidney disease patients on hemodialysis and those on conservative treatment in comparison with control subjects. Materials and methods: Ninety subjects were included in this study divided into three groups: 30 patients with chronic kidney disease on hemodialysis for at least 6 months ago; 30 patients with chronic kidney disease on conservative treatment and 30 healthy control subjects. Secretory immunoglobulin A, inte
... Show MoreBackground: Type 2 diabetes mellitus (T2DM) characterized by insulin resistance (IR) and progressive decline in functional beta (β) cell mass partially due to increased β cell apoptosis rate. Pancreatic stone protein /regenerating protein (PSP/reg) is produced mainly by the pancreas and elevated drastically during pancreatic disorder. Beta cells are experiencing apoptosis that stimulate the expression of PSP/reg gene in surviving neighboring cells, and that PSP/reg protein is subsequently secreted from these cells which could play a role in their regeneration.
Objectives: To analyze serum levels of PSP/reg protein in T2DM patients and evaluate its correlation with the microvasc
... Show MoreThe agricultural activity has a great significance in the all four dimensions of sustainable development. Firstly, the economic dimension which it contributes with the GDP, as well as, it is considered as an important source to attract the investment. Secondly, the environmental dimension which also contributes with conserving of the biodiversity, combating the desertification, and increasing the farmlands. Thirdly, for its role in the social dimension to achieve the food security, to eradicate the poverty, and providing jobs. Fourthly, toward the institutional dimension as well it is considered as a source that allows all people to participate effectively, and to exchange of the local and universal experiences and perspectives. For conf
... Show MoreThis study aimed to recognize and understand the concept of strategic management accounting (SMA) and how it's the effect on the competitive advantage for industrial companies in Jordan. The study's importance arises due to the lack of Arab studies that dealt with this topic, in addition to the important and vital role of strategic management accounting on companies that represent the artery of the decision-making process, and to identify the benefits associated with SMA technology. The necessary data were collected through the literature review and theoretical study of the references that relevant to the study subject, in addition to a questionnaire developed for this purpose, the study used (124) out of (250) questionnaires tha
... Show MoreThe goal of the research is to highlight the role of the governance and its characteristics in increasing the tax outcome by implementing the laws, regulations and annual controls issued annually from the general authority for taxation for the financing of the general treasury of the state, Additional development and economic capacity, As the search shares a view of the governance and its characteristics and its ideas from increasing tax output. The analytical transparent approach was used by adopting the practice of practicalities of the general authority for tax For quotations in the senior cabinet section ,the revealing of the ongoing operations was relied on the revenue for each financial year, The tools adopted in the process of ana
... Show MoreThe poster is one of the means which can be communicate with others through it, to transfer ideas that the designer want to focus on, for its importance to accomplish the poster. It’s a visual mean contact aim to submit an idea to the audience to get a clear idea, and that would be through the shapes and subject to submit the idea. Depend on that our goal in this study is to find out, what follows:1-Finding the relationship between the shape and the idea.And the study comes up with several results, like:1-The drawings that contain themes connected with what the designer want to achieve, through the clearness of idea and to make those elements clear by putting more elements to surround the main shape.2-To assure that the strong connecti
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