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 systemic and resistant nature of metastatic castration-resistant prostate cancers (mCRPC) renders it largely incurable even after intensive multimodal therapy. Proliferation, survival, and epithelial-mesenchymal transition (EMT) are three fundamental events that are deeply linked to carcinogenesis. Hence, it is necessary to find a new combination of several therapies, targeting those vital mechanisms without causing side effects. Significant research works have shown differential low expression of the metabolic Farnesoid X receptor (FXR) in primary and metastatic prostate cancer suggesting their importance in prostate pathogenesis. Obticholic acid (INT 747), a potent FXR agonist is widely used in primary biliary chola
... Show MoreThe Research aims to determine role of The Intellectual capital in the performance of small and medium enterprises , to achieve this goal through a researcher from the theoretical literature and studies related to the construction of the scheme shows the hypothetical relationship between the variables, which was adopted by the independent variable intellectual capital, distributed four variable are:( human capital, structure capital ,customer capital, innovation capital) as well as four variable (the financial perspective, the customer perspective, process perspective ,the learning & growth perspective) The study were getting to many results as bellow :the intellectual capital in the small and intermediate p
... Show MoreSummary: The study focused on the role of the educational counselor in schools, as an integral part of the educational system that faces multiple challenges and difficulties. In this context, the counselor’s role becomes crucial in attempting to reduce or eliminate such difficulties, in addition to guiding students in an appropriate manner. Methodes: The study employed a descriptive field approach, using interviews and direct observation as tools to examine the actual role performed by school counselors. Results: The study concluded with several key findings, most notably the numerous challenges faced by counselors, including students’ negative behaviors, school dropouts, and the limited administrative support for counselors’ work. Fu
... Show Morethe history of the Scouting movement reflects the global social cultural and technological change over more than a century. scouting aims to develop young people worldwide through educational programs based on specific principles and values. in arab countries, the scouting movement is considered one of the most important platforms contributing to developing young people and enhancing their rule. positive in society, began with the establishment of the first Scout camp in the region and witnessed great growth and prosperity over the decades the research reveals the historical roots and development of the scout movement in the leading arab countries and analyzes the positive impact of scout movement in the leading arab countries on the develo
... Show MoreThis paper presents the syntactic dimension of ditransitive verbs in terms of the universal theory of Role and Reference Grammar (RRG). This theory is syntactic in nature, but it also covers the semantic as well as the pragmatic aspects of any linguistic phenomenon. It assumes a universal framework through which syntactic constructions can be analyzed. However, the morphological structure that each language enjoys renders the universal treatment more complicated and can question the universal nature of such a theory. In this paper, an attempt is made to check if the universal tenet of the theory is maintained over two typologically different languages: English and Arabic in respect of the way that double-object constructions (DOCs)
... Show MoreIndustrial product is one of the things of daily use and direct interaction with the user, so the ranges of its association to the user, took a varied and multiple aspects. The user today sees the products as things have specifications related directly to the psychology of the user, so he can reflects his values, principles and ideas on the composition of the total structure of the product, making them a means by which manifested the internal entity's of the user took an external materiality. And then counting the products being things excite positive feelings among different user was a natural result given the complexity of the relationship between the user and the industrial product. So pleasure is one important effects that result fro
... Show MoreAbstract This study aims to compare British war poetry of the First World War with Iraqi poetry from the mid-20th century with special reference to Iraqi war poetry of the 1980’s Iraq-Iran War and the period that followed it. It will also investigate the influence of the designated British war poetry on the chosen body of Iraqi poetry. Through the comparison of sample poems the study presents, firstly, the direct influence of the British poetry of the Great War and its translation which formed the seeds of a more radical movement in Iraqi poetry during the 1980’s Iran/Iraq War and the period that followed it. The study also presents a comparison of the works of British and Iraqi civilian poets during and after the war time and their con
... Show MoreThe most important contemporary issues which related to the survey of the influence of communication development technology to land use sustainability. The research aims to explain the changes that happened in the quality & land use activities performance by understanding the transformations due to modern technology and its impact on current uses and its impact on changing functional relationships between those uses to create new combinations or hybrid uses.Research will follow the analytical descriptive approach in presenting the problem of research. Research has several conclusions & recommendations, one of conclusions is the change of the place concept and its relation to changing the concept of land use and its sustai
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This study is concerned with the reality of total quality management and its role in achieving the excellence performance of the employees of the Institute of Technology / Baghdad, excellence performance is described by the extent to which the organization is able to invest the effort of the human resource to achieve its Objectives by adopting the principles of Total Quality Management (TQM) according to some of its basic dimensions in proportion to the reality and Possibilities Institute, the aim is to study to know the reality of total quality management ,and indicate the levels of excellence performance in the Institute of Technology / Baghdad,
... Show MoreDue to the developments taking place in the field of communications, informatics systems and knowledge management in the current century, and the obligations and burdens imposed on the business organization to keep pace with these developments, the traditional methods of administrative decision-making are no longer feasible, as recent trends have emerged in management that focus on the need to rely on quantitative methods such as operations research.. The latter is one of the results of World War II, which appeared for the first time in Britain to manage war operations. The first method used in this field is the linear programming method. The use of operations research has developed greatly in the past years, and the methods of analysis in
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