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The Surgical outcomes of fundus-first technique in lowering the rate of bile duct injuries and bleeding during open cholecystectomy that facing intraoperative difficulties: A single-center prospective study: The surgical outcomes of open fundus-first cholecystectomy technique.
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Background: The problem of difficult gallbladder is not clearly defined and associated with real missing of therapeutic approaches that decreased morbidity. Moreover, the difficult gallbladder was reported as a contributing risk factor for biliary injury due to raised difficulty in surgical dissection within Calot’s triangle. The aim of this study is to determine the surgical outcomes of the open fundus-first cholecystectomy in lowering the rate of lethal intraoperative risks.

Subjects and Methods: Our prospective study conducted during the period of January 2019 to December 2022 at Ibn Sina specialized hospital, Khartoum, Sudan, for two hundred and fifty-three patients underwent elective open fundus-first cholecystectomy for intraoperative difficulties.

Results: the majority of cases had long-standing cholelithiasis with intraoperative difficulties revealed by pre-operative TUS and MRCP which required open fundus-first cholecystectomy in 173 (68.4%) of patients, (P-value <0.05). The operative surgical time was 120 minutes in 103 patients (40.7%), (P-value <0.05). During open cholecystectomy, variable intraoperative difficulties were found in all patients, (P-value <0.05) and were divided into: (A) Contracted intra-hepatic gallbladder seen in 157 (62.1%) of cases; (B) Distorted anatomy within Calot's triangle seen in 135 (53.4%) of patients; and (C) Intraoperative bleeding from the liver bed was observed as bloody oozing form in 150 (59.3%) of cases. Our patients had minimal postoperative complications like mild wound infection in 8 (3.2%) of cases and mortality rate was zero. 

Conclusions: There is a need for appropriate therapeutic and preventive strategies in healthcare systems for safe dealing with difficult cholecystectomy. Unclear anatomy due to severe inflammatory dense adhesions at Calot’s triangle and CBD stones needing difficult surgeries are the most important limiting factors for fundus-first laparoscopic cholecystectomy. Hence, we humbly recommend an open approach of fundus-first cholecystectomy as safe surgical option to reduce the incidence of bile duct injuries and intra-operative bleeding.

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Publication Date
Mon Oct 01 2018
Journal Name
International Journal Of Research In Social Sciences And Humanities
THE SOCIAL INTERACTION OF LANGUAGE IN A COMIC SERIES: A SOCIOLINGUISTIC STUDY
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Dell Hymesin 1964coined The Ethnography of Communication in an attempt to explain the ways in which people use the language to interact. It hypothesizes that ethnography is less applicable among participants who have the same sociocultural background. It was proven that all the basic speech components occur whenever there is an interactional situation. The elements of (SPEAKING) schema are closely connected. However, the findings establish the fact that these elements take place effectively among participants who have the same sociocultural background.One of the most outstanding conclusions is the capability of the (SPEAKING) model to analyze not only an interaction between two or more participants, but also any event which consists of a mo

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Publication Date
Thu Oct 17 2019
Journal Name
International Journal Of Research In Social Sciences And Humanities
A CRITICAL DISCOURSE ANALYSIS OF RHETORICAL DEVICES OF TRUMP&#39;S AND MAY&#39;S SPEECHES DURING THE PERIOD 2017 TO 2019
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DBNRHM Sami, International Journal of Research in Social Sciences and Humanities, 2020

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Publication Date
Thu Sep 12 2019
Journal Name
Al-kindy College Medical Journal
The outcome of newborn admitted in neonatal care unit, center teaching hospital of pediatric , Baghdad Al-krakh, 2015
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Background: Neonatal period is a very vulnerable period of life due to many problems, In spite of advances in perinatal and neonatal care still, the mortality rate of neonate high especially in developing country The World Health Organization estimates that globally four million neonatal deaths per year, Developing countries account for around 99% of the neonatal mortality in the world, In Iraq. Neonatal mortality rate about 19 per 1000 live births which represent 56% of child death below 5 years age in 2012. The hospital in the study represents the larger pediatric hospital in Iraq. It contains 400 children's beds and 24 neonatal incubators.

Aims of the study: are to determine the institutional

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Publication Date
Wed Jun 01 2011
Journal Name
Journal Of The College Of Languages (jcl)
Новые направления и течения начала Серебряного века The Silver Age and the New Trends That appeared at the Twentieth Century.
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    Годы, принадлежащие концу XIX – началу XX столетия, вошли в русскую литературу под красивым названием Серебряный век. В это время в стране появился целый ряд выдающихся поэтов, имена которых навсегда останутся в русской и мировой литературе. Это Ахматова, Гумилев, Блок, Маяковский и многие другие. Все эти люди творили в нелегкое для России время. Началом Серебряного века условно считают 189

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Publication Date
Sat Dec 01 2012
Journal Name
Journal Of Economics And Administrative Sciences
Developing strategic leadership practices in the light of transparency and organizational citizenship behavior - A field study of a sample of the staff of the Office of the Inspector General at the Iraqi Ministry of Culture
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Diversity the terms and practice the organizational filed with different concepts and environment, which Iraqi environment part from them. Some organizational in Iraqi environment leave its basic oriented to agreement with the leader desire, their fore this research focus tow basic variable (organizational citizenship behavior & transparence), we supposition which is dependent to explanation the response variable (strategic leadership). The results justification in part and not justification in another part. For example the organizational citizenship behavior effect on some parte of the strategic leadership. The transparence have faraway to fly from the relation with organizational citizenship behavior and strategic leadershi

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Publication Date
Thu Mar 09 2023
Journal Name
Tajseer Journal For Multidisciplinary Research And Studies
The General Principle Governing the Duty of Care – A Study in Light of English Law
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The duty of care is the essence of the error of negligence under the English legal system, and without it, responsibility for negligence cannot be judged, regardless of the extent of the damage incurred. contained in English law. In view of the importance of proving the existence of the duty of care on the defendant so that it is possible to judge his responsibility for negligence, the need arises to find a general principle to which the defendant is subject in order to decide whether he owes the plaintiff with the duty of care and therefore responsible for the negligence, and this is what we will explain in the research topic the study.

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Publication Date
Sun Feb 01 2026
Journal Name
Al-adab Journal
Western Hermeneutics and Heritage: A Contemporary Study in the Debate of Understanding and Horizon.
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Publication Date
Wed Jan 01 2014
Journal Name
Department Of Bioengineering And Sciences
1 T.R. KAHRAMANMARAŞ SÜTÇÜ İMAM UNIVERSITY GRADUATE SCHOOL OF NATURAL AND APPLIED SCIENCE Cloning and overexpression of Lactobacillus acidophilus bile salt hydrolase A gene (bshA) in Escherichia coli
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The bile salt hydrolase gene (bshA), encoding bile salt hydrolase enzyme (EC 3.5.1.24) from probiotic isolate Lactobacillus acidophilus Ar strain which is responsible for assimilation cholesterol were studied in the present work. About 801 bp in length DNA fragment of Lb. acidophilus Ar strain was amplified by PCR techniques. Two restriction sites (PstI/SacI) were added to each end of that fragment for manipulation of DNA during cloning. Amplified fragment inserted into pJET1.2\blunt end vector and pMG36e vector respectively. pJET1.2\blunt end vector is overexpression plasmid for E. coli MC1022, and pMG36e vector is a shuttle vector which is able to replicate in both E. coli and lactic acid bacteria. The resulted constructs were named as pJ

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Publication Date
Sat Jul 01 2017
Journal Name
Al–bahith Al–a'alami
The Use of Digital Public – Relations in the Work of Iraqi Universities: A Survey Study of the Workers in the Departments of Public Relations
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the digital public relations aim at make the workers getting the necessary information about the governmental institutions where they work and the enveronment surrounding them. it also tries to let the workers get the special knowlege of tthe publich relations and their jobs like the works of planning , arranging the active communication and executive skills needed in their writing , editing , special art skills for designing , production and technological skills to deal with the computer.
the problem of the research includes some questions as :
1- what are the uses achieved by degetal public relations workers at Iraqi universities (Baghdad, Mustansiriya, and Iraqi)
2- what are the tools used to apply digital public relations

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Publication Date
Wed Jan 01 2020
Journal Name
Plant Archives J.
Evaluation of the performance of triple, single crosses and their inbred in bred lines of maize under two plant population
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