Background: Acute cholecystitis is common surgical
problem, which was treated previously by conservative
treatment .Later early open has been introduced as an
alternative to interval for treatment of acute cholecystitis.
Early open was found to be a safe, successful with
comparable postoperative complication rate. With the
advent of laparoscopy laparoscopic have been used for
chronic cholecystitis and became the first line of
treatment. New reports have shown that laparoscopic can
be used as an alternative to open for surgical treatment of
acute cholecystitis.
Objectives: to compare the success, safety of early
laparoscopic versus early open as a primary treatment of
acute cholecystitis.
Methods: out of 68 patients were treated for clinical
acute cholecystitis between January 2002 and February
2004 in the department of surgery, at Al – Kindy teaching
hospital. A total of 62 patients underwent early for acute
cholecystitis as soon as possible after diagnosis. The
preferred preoperative imaging technique was ultrasound.
30 (48.3%) of the operations were attempted
laparoscopically, whereas the remaining 32 patients
(51.7%) underwent initial open .
Results: The mean operative time for the open cases
was 75 minutes versus 60 minutes for the laparoscopic
group. There was no perioperative mortality in either
group. The incidence of conversion to open was 10% (3
patients). Surgical complications related to laparoscopic
and open occurred in 2 (6.6%) and 3 (9.3%) cases,
respectively. There was no difference between the open
and laparoscopic groups in regard to the major
postoperative complications.
Conclusion: The current study shows that early
(whether performed by open or laparoscopically) is a
safe and effective treatment for acute cholecystitis. Low
conversion rates can be maintained with strict guidelines
for appropriate patient selection, adequate experience,
and proper laparoscopic technique.
The conception and experimental assessment of a removable friction-based shear connector (FBSC) for precast steel-concrete composite bridges is presented. The FBSC uses pre-tensioned high-strength steel bolts that pass through countersunk holes drilled on the top flange of the steel beam. Pre-tensioning of the bolts provides the FBSC with significant frictional resistance that essentially prevents relative slip displacement of the concrete slab with respect to the steel beam under service loading. The countersunk holes are grouted to prevent sudden slip of the FBSC when friction resistance is exceeded. Moreover, the FBSC promotes accelerated bridge construction by fully exploiting prefabrication, does not raise issues relevant to precast co
... Show MoreSimulated annealing (SA) has been an effective means that can address difficulties related to optimization problems. is now a common discipline for research with several productive applications such as production planning. Due to the fact that aggregate production planning (APP) is one of the most considerable problems in production planning, in this paper, we present multi-objective linear programming model for APP and optimized by . During the course of optimizing for the APP problem, it uncovered that the capability of was inadequate and its performance was substandard, particularly for a sizable controlled problem with many decision variables and plenty of constraints. Since this algorithm works sequentially then the current state wi
... Show MoreMulti-walled carbon nanotubes from cheap tubs company MWCNT-CP were purified by alcohol \ H2O2 \ separation funnel which is simple, easy and scalable techniques. The steps of purification were characterized by X-ray diffraction, Raman spectroscopy, scanning electron microscopy SEM with energy dispersive of X-ray spectroscopy EDX and surface area measurements. The technique was succeeded to remove most the trace element from MWCNT-CP which causing increase the surface area. The ratios of impurities were reduced to less 0.6% after treatment by three steps with losing less than 5% from MWCNT-CP.
This paper presents a robust control method for the trajectory control of the robotic manipulator. The standard Computed Torque Control (CTC) is an important method in the robotic control systems but its not robust to system uncertainty and external disturbance. The proposed method overcome the system uncertainty and external disturbance problems. In this paper, a robustification term has been added to the standard CTC. The stability of the proposed control method is approved by the Lyapunov stability theorem. The performance of the presented controller is tested by MATLAB-Simulink environment and is compared with different control methods to illustrate its robustness and performance.
Machine learning models have recently provided great promise in diagnosis of several ophthalmic disorders, including keratoconus (KCN). Keratoconus, a noninflammatory ectatic corneal disorder characterized by progressive cornea thinning, is challenging to detect as signs may be subtle. Several machine learning models have been proposed to detect KCN, however most of the models are supervised and thus require large well-annotated data. This paper proposes a new unsupervised model to detect KCN, based on adapted flower pollination algorithm (FPA) and the k-means algorithm. We will evaluate the proposed models using corneal data collected from 5430 eyes at different stages of KCN severity (1520 healthy, 331 KCN1, 1319 KCN2, 1699 KCN3 a
... Show MoreThe negotiation phase is gaining great importance in investment loans due to the magnitude of the amounts awarded and the need to obtain adequate lending guarantees and the development of better conditions, and this requires that negotiating policy with fixed principles that balance between meeting the demands of customers and maintain market share and achieve profits and avoid defaults and losses the bank, and so I have touched Find the concept of investment loans and procedures for granting and the concept of the negotiation process for the granting of loans. The practical side to ensure the preparation of examination form consists of questions commensurate with the methodology developed by the researchers, were directed to the officia
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This research aims to analyze the reality of the production process in an assembly line Cars (RUNNA) in the public company for the automotive industry / Alexandria through the use of some Lean production tools, and data were collected through permanence in the company to identify the problems of the line in order to find appropriate to adopt some Lean production tools solutions, and results showed the presence of Lead time in some stations, which is reflected on the customer's waiting time to get the car, as well as some of the problems existing in the car produced such as high temperature of the car, as the company does not take into account customer preferences,
... Show MoreAsthma is one of the most common chronic, non-communicable diseases affecting children worldwide. The estimated prevalence of pediatric asthma in Iraq is 15.8%. Physiologic, inflammatory and structural factors contribute to the development of asthma. Assessment and monitoring of asthma control can be done by a validated children asthma control test (CACT). Management of asthma must address three components which are an appropriate management plan, the most appropriate medication if necessary, and the use of safe and effective medication. The management plan should consider patient counseling and education about the definition of asthma, signs, and symptoms, the pathophysiology of asthma, common triggers for asthma and how can avoid them,
... Show MoreDuring the 1970s, communicative view of language teaching began to be incorporated into syllabus design. The central question for the proponents of this view was: what does the learner want/need to do with the target language? This lead to the emergence of a teaching method (or approach) called communicative language teaching (CLT) during the late 1970s and early 1980s focusing on the functions that must be incorporated into a classroom. According to Brown (2001:43) CLT is a unified but broadly based, theoretically well informed set of tenets about the nature of language and of language learning and teaching. Harmer (2001:84) states that the communicative approach is the name which was given to a set of beliefs which included not only a
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