Volume 15, Issue 2, Summer and Autumn 2019, Page 24-52

3D Reconstruction of Mandibular Defects using CAD/CAM Designed Zirconia Prosthesis

Kamal T. Aftan

Al- Anbar Medical Journal, 2019, Volume 15, Issue 2, Pages 24-29

Background: Reconstruction of mandibular defects with autogenous free bone graft is considered the preferred method. However, the optimum reconstruction technique of mandibular defects is still controversial. Objectives: To assess the efficacy and safety of the zirconia individual designed CAD/CAM prosthesis for the mandibular reconstruction. Materials and methods: We used a new method (zirconia prosthesis) for the reconstruction of mandibular defects due to various causes. The study was carried out in the Oral and Maxillofacial Department of Al-Ramadi Teaching Hospital during a period of 62 months from January 2012 to March 2017. Data were collected for each patient regarding the age, gender, site and cause of the defect, investigations, operative technique, complications, outcome, and the duration of the follow-up. Results: Twenty patients, 14 were men and 6 women; the patients’ ages ranged from 19 to 70 years. The majority of the defects were caused by tumors, while, 40% due to congenital or traumatic causes. The success rate of the prosthesis taking was 95%. And in these cases, esthetic and functional outcomes were restored or improved after the reconstruction in all subjects. Conclusion: We described a novel method for mandibular reconstruction with zirconium individual-designed CAD/CAM model. We advise to use this method owing to the high success rate, the less major rate of complications in comparison with other methods, and high rate of functional and esthetic outcome.

Comparison between Immediate and Delayed Weight Bearing in Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction

Majed A. Alsaad; Abdulkareem H. Alsaffa; Mohammed S. Alharris

Al- Anbar Medical Journal, 2019, Volume 15, Issue 2, Pages 30-34

Background: Anterior cruciate ligament (ACL) rupture is one of the most frequent orthopedic sports traumas. The treatment of choice for an ACL tear is ACL reconstruction and usually followed by 4-9 months of outpatient sports or orthopedic physical therapy. There are different exercises and regime variations in rehabilitation after surgery. Both weight-bearing and non-weight bearing exercises have been used and shown to be effective for rehabilitation in post ACL reconstruction and return to sport. Objectives: To compare the effect of immediate and delayed weight-bearing in a rehabilitation protocol after ACL reconstruction. Materials and methods: Forty patients with an ACL injury with or without meniscal injury were included in the study. They divided into two groups, group A with immediate weight-bearing and group B delayed weight-bearing after surgery and we followed them with lysholm score and took results before surgery, after 3 months, and after 6 months from surgery. Results: Results of the mean value of lysholm score before surgery group A 65.40 and group B 66.90 with P-value 0.421, after 3 months group A 81.55 and group B 81.75 with P-value 0.904 and after 6 months from surgery group A 91.65 and group B 92.25 with P-value 0.675. Conclusion: There is no functional difference between immediate weight-bearing and delayed weight-bearing after ACL reconstruction. Clinically immediate weight-bearing better than delayed weight-bearing by improving muscle performance around the hip and knee and improve the condition of the cartilage, immediate weight-bearing not harmful on the knee joint or ACL graft

Review of 120 Cases of Intussusception among Infants and Young Children in Al-Qaim General Hospital

Hamdi Noori Al-Aloos; Ammar Fouad Abdul-razzaq; Muneam Afatan Ayyed

Al- Anbar Medical Journal, 2019, Volume 15, Issue 2, Pages 35-39

Background: Intussusception is an emergency condition, mostly affecting the infants and toddler children and leads to small intestinal obstruction. Objectives: To evaluate the presentation, management outcome and the benefit of early diagnosis and treatment. Materials and methods: During the period (1986 to 2010), 120 patients with intussusception were retrospectively reviewed who they were admitted and followed up and treated in Al-Qaim General Hospital, Al-Anbar governorate, Iraq. Results: There were 80 boys and 40 girls with a ratio of 2:1, ranging in age from 2 months to 7 years, 3/4 of them were ≤ 1 year with a peak incidence in spring and early winter. Eighty percent of patients presented within the first 24 hours. On presentation, the following symptoms and signs were vomiting (80%), colicky abdominal pain (75%), abdominal mass (70%), red currant jelly stool (70%). Classical presentation only found in 25% of patients. There were 26 patients with a positive family history. All patients diagnosed clinically and confirmed operatively in those whom operations were done for them. The basic treatment is a surgical reduction in 95% of cases, 3 patients treated by Barium enema reduction and the other 3 patients treated conservatively as cases of Henoch-Schonlien purpura. Sixteen patients (14.03%) needed bowel resection, due to late presentation. The mortality rate was 4.16% due to gangrene of bowel, bowel perforation, and electrolyte imbalance. The ileocolic site was the most common in (86.84%) patients and there were 2 recurrences. Conclusion: In order to minimize morbidity and mortality from intussusception, steps must be taken to ensure earlier diagnosis and treatment.

Pattern of Congenital Heart Disease among Children Referred for Echocardiography in Ramadi City, West of Iraq

Fakhri J. Al-Dalla A; Mustafa D. Hammood; Khamees M. Al-Dulaim; Bassim M. Salman

Al- Anbar Medical Journal, 2019, Volume 15, Issue 2, Pages 40-44

Background: Congenital heart disease (CHD) carries a high rate of mortality and morbidity in the pediatric population. The gold standard technique for diagnosing CHD is echocardiographic examination. Objectives: To assess the CHD pattern among children referred for echocardiography in Ramadi city, west of Iraq and to determine the correlation of various types of CHD with age and gender. Materials and methods: The study conducted at Maternity and Children Teaching Hospital in Ramadi. All patients who evaluated by echocardiography from June 2013 to March 2015 were included in this study. All children were evaluated by transthoracic echocardiography using M-mode by a pediatrician trained in pediatric ECHO. The pattern of CHD was studied, taking into consideration age and gender distribution. Results: The age range of our 262 patients was 1 day to 14 years (mean 16.6±30.3 months) and the male to female ratio 1.04:1. Acyanotic CHD comprises 87% of the cases. There were 188 (71.76%) patients diagnosed in infancy. Ventricular septal defects (29.39%) were the commonest type, atrial septal defects (16.03%) were the second, and the least Ebstein anomaly (0.38%). The commonest cyanotic cardiac defect was Fallot Tetralogy. There was a male predominance in ventricular septal defects, Tetralogy of Fallot, aortic stenosis, coarctation of the aorta, and D-transposition of the great arteries. While, female predominance observed in atrioventricular canal defect, atrial septal defects, patent ductus arteriosus, and pulmonary stenosis. Conclusion: CHD mostly diagnosed in the infants. Acyanotic CHD was the commonest defect. Ventricular septal defects were the commonest acyanotic defect. While Fallot Tetralogy was the commonest cyanotic CHD. Sex distribution was comparable to that observed in the studies from other parts of the world.

Acquired Lymphangiectasia of the Scrotum: A Case Report

Abdullah Mancy

Al- Anbar Medical Journal, 2019, Volume 15, Issue 2, Pages 45-47

The majority of cutaneous lymphangiomas are congenital in origin. Occasionally they arise fromacquired lymphatic obstruction. The scrotum is rarely subjected to lymphatic malformations.These affecting the scrotum usually present with multiple, translucent, thick-walled vesicles, attimes their surfaces are verrucous which may be mistaken for genital warts, and frequently consistof a combination of blood and lymph elements that may be confused with vascular tumors such asangiokeratomas. Idiopathic acquired lymphangiectasia is seldom registered as a reported case inthe literature. We reported a further case of acquired lymphangiectasia of the scrotum in a 27-yearold male without any obvious predisposing factor.

Diarrhea as Atypical Symptom of Acute Myocardial Infarction

Hazim Ghazzay; Ammar Kamil

Al- Anbar Medical Journal, 2019, Volume 15, Issue 2, Pages 48-50

Acute myocardial infarction (AMI) is commonly known to be presented with chest pain, radiatedto the left arm, neck or jaw. However, many cases were documented to be presented with atypicalsymptoms. One of the rarest presentations of AMI is diarrhea. We were reporting a case of a55-year gentleman who was complaining of diarrhea without chest pain, found to have an inferiormyocardial infarction (MI) by routine ECG. No, any other cardiac symptoms were found. Thishighlights that diarrhea can be the only presenting symptom of acute MI which likely to be missed.The importance of knowing the presenting symptom of AMI will help a lot in giving the bestmanagement to the patient during the golden hours of the hospital arrival, which might be life-saving.