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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
Sun Jun 01 2014
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Suggested Model for The Work of the Certified Fraud Examiner & His Role in Reducing The Incidents of Fraud and Corruption: An Applied Study in The Federal Board of Supreme Audit
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Is hardly day expire without hearing the news either Abuse Managementthe accounting standards or the existence of serious misstatements by someauditors.Which caused the demanding of many companies in the recent republication of the financial statements and the re-announcement of its financialresults. Such acts raise questioning about the role that should be played by theauditors, prompting agencies responsible for setting auditing standards to takeTo throw increasingly responsibility on the auditors in order to interest risksfraud The Risks of Fraud in their review of the financial statements.also The Public Company Accounting Oversight Board in the U.S.called about the need of owning the Certified Public Accountants those whoaudits for

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Publication Date
Sat Feb 09 2019
Journal Name
Journal Of The College Of Education For Women
The Romantic Nightingale between Coleridge’s Divergence and Keats’ Adherence: A comparative Study between Coleridge’s ‘The Nightingale’ and Keats’ ‘Ode to a Nightingale’
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‘Ode to a Nightingale’(1819) is a typical poem of a Romantic poet like John Keats, but
‘The Nightingale’(1798) is an uncharacteristic poem of a Romantic poet like Coleridge.
The paper proposes a comparison between Coleridge’s ‘The Nightingale’ and Keats’
‘Ode to a Nightingale’.Coleridge’s poem diverges from the Romantic norm; it carries some
characteristics new to Romantic poetry like the realistic and objective portrayals of nature and
the nightingale, while Keats’ poem adhere to the characteristics of Romantic poetry; it
portrays nature and the nightingale subjectively and unrealistically. Coleridge’s poem is very
much influenced by the scientific approaches to environment, and natural his

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Publication Date
Sat Jan 27 2024
Journal Name
Caspian Journal Of Environmental Sciences,
Morphological study on the form and number of eyes in scorpions and spiders
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Scorpions and spiders belong to the class Arachnida in phylum Arthropoda. Scorpions are easily distinguished by median eyes on obvious the center of the carapace and have one pair, and lateral eyes have 2-8 in some species. Scorpions do not have good eyesight so the median eyes have always been simple and they are more sensitive than the lateral pairs. They have anterior median eyes (AME) with narrow field of view and pairs of lateral eyes (LE) with more sensitivity and response to light. Family Buthidae have 2-6 lateral eyes in Compsobuthus Mesobuthus, Hottentotta, while Vaejovidae, Chactidae and Chaerilidae have 2 pairs of lateral eyes. In addition, 3 pairs are found in Orthochirus and Androctonus. Spiders have six eyes in family Pholicid

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Publication Date
Mon Mar 08 2021
Journal Name
Baghdad Science Journal
Performance quality of single and ?two stage solar concentrators
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The performance of single and two stage solar concentrator were studied ' " The ratio of the primary to the secondary mirrors diameter is taking to be 0.5, depending on the theoretical calculation for the accumulated energy by the concentrator with ratio between 0.0 to 0.9. The design of the systems were designed and examined by using a ray-tracing program. The efficiency of the single and the two stage concentrators are calculated and compared with and without cooling systems.

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Publication Date
Mon Jul 10 2023
Journal Name
Journal Of Engineering
Design and Implementation of Single-Phase Boost PFC Converter
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In this paper, a single-phase boost type ac-dc converter with power factor correction (PFC) technique is designed and implemented. A current mode control at a constant switching frequency is used as a control strategy for PFC converter. The PFC converter is a single-stage singleswitch boost converter that uses a current shaping technique to reshape the non-sinusoidal input current drawn by the bulky capacitor in the conventional rectifier. This technique should provide an input current with almost free-harmonics, comply with the IEC61000-3-2 limits, and a system operates with near unity power factor. The other function of the boost converter that should be
accomplished is to provide a regulated DC output voltage. The complete designed

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Publication Date
Mon Apr 01 2019
Journal Name
Journal Of Educational And Psychological Researches
The Effectiveness of a Teaching Strategy Based on the Cognitive Model of Daniel in the Development of Achievement and the Motivation of learning the School Mathematics among the Third Intermediate Grade Students
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This research aims to examine the effectiveness of a teaching strategy based on the cognitive model of Daniel in the development of achievement and the motivation of learning the school mathematics among the third intermediate grade students in the light of their study of "Systems of Linear Equations”. The research was conducted in the first semester (1439/1440AH), at Saeed Ibn Almosaieb Intermediate School, in Arar, Saudi Arabia. A quasi-experimental design has been used. In addition, a (pre & post) achievement test (20 Questions) and a (pre & post) scale of learning motivation to the school mathematics (25 Items) have been applied on two groups: a control group (31Students), and an experimental group (29 Students). The resear

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Publication Date
Thu Jan 30 2020
Journal Name
Int’l Journal Of Advances In Chemical Engg., & Biological Sciences
In vivo Study of Effects of Citric from Aspergillus Niger and Lemon Juice on the Hormonal Level and Histoarchitecture of the Testis
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To study the qualitative changes in testis tissue after carbon tetrachloride (CCl4) administration and to determine whether citric acid (CA) has a protective effect against testis damage induced by CCl4. This study compared two types of CA by measuring the histoarchitecture of the testis and serum levels of progesterone, estrogen and testosterone on mice. One of the most produced organic acid is citric acid. In this study, CA produced by microbial fermentation using Aspergillus Niger 5mg/kg and derived from citrus limon 400mg/kg (lemon). Mice were treated with daily intraperitoneal (i.p.) injection for seven successive days after randomly separated into six groups: (1) control, (2) CCl4 (0.02%), (3) limon citric acid (400 mg/kg), (4) CCl4 (

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Publication Date
Fri Jul 21 2023
Journal Name
Journal Of Engineering
Study the Effect of Ceramic Coating on the Performance and Emissions of Diesel Engine
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In this study, the effect of ceramic coating on the performance and gases emission on diesel engine was investigated. A four-stroke, direct injected, single cylinder, diesel engine was tested at constant speed and at different load conditions without coating. Then, the inlet and exhaust valves faces were coated by about 500µm with ceramic materials. Ceramic layers were made of YttriaStabilized Zirconia (YSZ), and NiCrAl as a bond coat. The coating technique adapted in this work is the flame spray method. The engine with valves ceramiccoated research was tested for the same operation conditions of the engine (without coating). The results indicate a reduction in both fuel consumption by about 7.6% and particulate emissions by about (13

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Publication Date
Sat Aug 01 2020
Journal Name
International Journal Of Psychosocial Rehabilitation
Building and legalizing a test for evaluating the tactical learning of the footwork for the foil fencer in the fencing game
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AA wahid, journal mustansiriyah of sports science, 2023

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Publication Date
Tue Mar 12 2024
Journal Name
Semiconductor Physics, Quantum Electronics And Optoelectronics
Numerical study of single-layer and interlayer grating polarizers based on metasurface structures for quantum key distribution systems
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Polarization is an important property of light, which refers to the direction of electric field oscillations. Polarization modulation plays an essential role for polarization encoding quantum key distribution (QKD). Polarization is used to encode photons in the QKD systems. In this work, visible-range polarizers with optimal dimensions based on resonance grating waveguides have been numerically designed and investigated using the COMSOL Multiphysics Software. Two structures have been designed, namely a singlelayer metasurface grating (SLMG) polarizer and an interlayer metasurface grating (ILMG) polarizer. Both structures have demonstrated high extinction ratios, ~1.8·103 and 8.68·104 , and the bandwidths equal to 45 and 55 nm for th

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