Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is an infrequent and often missed diagnosis among patients presenting with acute coronary syndrome (ACS). Unfortunately, SCAD can result in significant morbidities such as myocardial ischemia and infarction, ventricular arrhythmias and sudden cardiac death. Lack of angiographic recognition from clinicians is a major factor of under-diagnosis. With the advent of new imaging modalities, particularly with intracoronary imaging, there has been improved diagnosis of SCAD. The aim of this paper is to review the epidemiology, etiology, presentation, diagnosis and management of SCAD.

The War Vascular Injuries

The incidence of vascular injuries resulting from war injuries has increased in Syria due to the conditions of war. It was previously considered rare and rare for a long time, This constituted a great challenge to vascular surgeons in particular, and surgeons in general, because of the seriousness of these injuries, whether the risk of vascular damage or the risk of accompanying injuries such as bone fractures or nerve injuries; etc. This may led to a disastrous results such as; partial or total limb amputation, or limb incompetence. These kinds of injuries were considered a real medical conditions, cause for several reasons, including: the lack of medical Experiences and medical staffs in this particular field, as well as the lack of diagnostic and treatment methods, and their high costs due to the conditions of war.

Reconstruction of soft tissue defects in the leg using muscle flaps (gastrocnemius، soleus) and fasciocutaneous flaps (sural)

Background: The defects in the leg is one of the most important challenges facing reconstructive surgeons because of the lack of soft tissue covering the front surface of the leg and the lack of blood perfusion in the lower third of the leg. The muscle and fasciocutaneous flaps are one of the most important reconstruction options as there have been no local studies about this method so far. Objective: Evaluation of methods of reconstruction the defects of the soft tissues of the leg using the muscle flaps and fasciocutaneous flaps and comparing them with the international studies. Methods: The study included 25 patients undergoing transposition of the gastrocnemius and / or soleus flaps, sural flaps for treating soft tissues in the leg, from 2015 to 2017 in both Al-Asaad and Tishreen University hospitals in Lattakia , gathering information on the etiology the lesion, the time of reconstruction, the flap used to cover the lesion, and the function of the gastrocnemius-soleus unit, and the following Sensory disorders.

A Laboratory and Clinical Comparison of National Local Formulation and Universal Formulation of Topical Prednisolone Acetate 1% in Reducing Inflammation After Phacoemulsification

Purpose: To evaluate and compare the pharmacological characteristics and clinical efficacy of two topical steroid prednisolone preparations (Redmond®, prednisolone acetate 1%; and Pred Forte®, prednisolone acetate 1%) in reducing postoperative inflammation in patients having phacoemulsification surgery with IOL implantation, which will support our trust in national products considering it's availability and lower costs compared with universal products. Methods: I- Laboratory Study: Direct microscopic examination of the ophthalmic suspension for both formulations. II- Clinical Study: This study was interventional, prospective, randomized controlled study included 60 eyes of patients undergoing emulsification surgery with IOL implantation. Patients were assigned to one of two treatment groups, The first group (30 eyes) received Redmond® while the second group (30 eyes) received Pred Forte® in addition to standard therapy. Study drug was administered postoperatively every 2 hours while awake for 7 days, then four times daily for 7 days, then twice daily for 7 days, then once daily for 7 days. Clinical efficacy was compared for differences in visual acuity, anterior chamber cells (scale 0-4), fundus and macula, drug's ocular adverse effects: foreign body sensation and irritation (scale 1-3), and intraocular pressure (IOP). Results were compared on day 1, day 3, 1 week, 2 weeks, and 1 month postoperatively. Results: I- Average particle size in ophthalmic suspension for both formulations was (< 1 μm). (Redmond® = 0.95 μm, Pred Forte® = 0.77 μm). II- No statistical differences in clinical efficacy or safety were seen between the two formulations tested at any time point evaluated with respect to visual acuity, anterior chamber cells, fundus and macula, foreign body sensation and irritation, and intraocular pressure (IOP). Conclusions: In this study of routine cataract patients, both prednisolone acetate 1% formulations are comparably effective and safe when administered for the reduction of inflammation after phacoemulsification surgery with IOL implantation. Direct microscopic examination showed that both formulations achieved the condition that particle size in ophthalmic suspension must be less than one micron.

The use of Cryosurgery with Liquid Nitrogen in the management of Physiological Gingival Melanin Pigmentation

The aim of the study was to assesst the effect of cryosurgery by means of liquid Nitrogen LN to manage the aesthetic problem caused by gingival melanin Pigmentation (GMP). The study is composed of 20 patients who attended the department of oral medicine at Tishreen University, Lattakia- Syria. Their chief complaint was GMP between November 1st 2013 and April 1st 2016. The clinical observation included caputuring photographs pre-procedure and 3 months, 6 months and a year post-procedure. Dummett Oral Pigmentation Index (DOPI) was used as a reference to indicate the colour of the pigmented areas degrees, and statistical analysis was performed by T-student test for paired samples. Ablation of hyperpigmented gingiva was accomplished with minimal discomfort and post-procedure healing was uneventful and with no post-pain. Such statistical study revealed a significant difference between pre- and post-procedure measurements of pigmented areas. In conclusion, the application of cryosurgery using LN appears to be an effective and safe method for elimination of GMP.

Clinical Study of Healing process as a Result of Using CO2 Laser in Management of Benign Tumors and Leukoplakia in the Oral Cavity

Objective: to study and evaluate the surgical operative process in the management of Benign Tumors and Leukoplakia in the Oral Cavity by using Laser CO2. Materials and methods: a total of 18 patients (10 males and 8 females) with mean age 50 years, and diagnosed with Benign tumorous Lesions or Leukoplakia on mucosa of the oral cavity, were treated by Vaporization by using CO2 Laser in Al-Assad university hospital. The postoperative complications were recorded within 7 days after the surgery, and the wounds was assigned until entire healing. Results: 8(44%) patients had week pain after 24 hour of surgery, and reduced to 2(11%) patients in the third day. Edema was seen by 8(44%) patients after 24 hour of surgery, and reduced to 1(6%) patient in the third day.5 (28%) patients showed disturbance within oral functions, and became 1(6%) patient in the third day. No complications were seen after 7 days of surgery. No infection or bleeding were recorded within following time.no statistically significant differences between Lesion kind and pain degree, and no relationship between Pain degree and Disturbance of the Lesions. Entire healing was satisfactory in all Wounds and no scar were seen . Conclusion: CO2 Laser is effective method in manage and minimize the complications during Healing process after the management of Benign Tumors and Leukoplakia in oral cavity.

Effect of deep breathing exercises on postoperative pain management in orthopedic patients in University Alassad Hospital

- Introduction: Postoperative pain is an important factor which exerts several physical effects in the cardiovascular, gastrointestinal, and urinary systems. In addition, psychologic effects that cause stress and anxiety. - Aim: This study aimed to examine the effect of breathing exercises on relieving postoperative pain in orthopedic patients. - Method: This study carried at Universal Alassad Hospital in Latakia, on a sample of 60 patients who underwent orthopedic surgery between March 2015 and June 2015, aged between 18-70 years. The sample was divided to two equal groups: control group (30) that has been left to hospital routine, and study group (30) that has been applied deep breathing exercises for 3 days after surgery as 3 times, each breathing exercise session took 5-10 minutes, then patients’ pain levelsin two group was assessed by verbal and visual pain scale.

Endoscopic Sinus Surgery of the Sphenoid with & without CT Navigation - A Comparative Clinical Study

We conducted a randomized clinical trial on 32 subjects in 2 groups with chronic diseases of the sphenoid sinus (each consisting of 16 patients) to evaluate CT navigation during Functional Endoscopic Sinus Surgery. All patients registered in our study met the widely accepted criteria to be treated with FESS. 16 patients were operated on with FESS with CT navigation while 16 patients were operated on with FESS without navigation. The result drawn showed no significant statistical difference in the outcome of the operations when we used the CT navigation during FESS compared with the time we did not use it. However, we believe it is an asset to the ENT surgeon in difficult and critical operations like the sphenoid sinus surgery as it brings precision and peace to the surgeon. We recommend using CT navigation as a useful adjunct added to the surgeon’s knowledge & experience but not as a replacement to these necessities.

Gastrointestinal stromal tumors (GISTs) Risk factors and surgical treatment

A retrospective study of 55 cases (mean age 55, range 82 ـ 35 years) of Gastrointestinal stromal tumors cancer admitted at AL Assad University Hospital , Lattakia , Syria. from 1\1\2002 to 1\1\2014 for studying its :locations ,risk factors and surgical management. Stomach was the most common site for GISTs in 52.27% , small intestinal in 30.90%, rectum in 9.09% and colon in 7.27%. The most common clinical signs and symptoms were: gastrointestinal bleeding 61.8% ,abdominal pain 21.81%.the histologic prognosis was high and moderate in 72.72% of patients. Total gastrictomy was performed for one patient ,subtotal gastrictomy for 16 patients and a wedge in 11 cases. In 6 patients a segementectomy of small intestinal were performed. and in one patient a resection of the upper rectum performed.

دراسة العوامل الإنذارية ومعدل البقيا بعد استئصال الكلية والحالب الجذري في أورام السبيل البولي العلوي

دراسة العوامل الإنذارية ومعدل البقيا بعد استئصال الكلية والحالب الجذري في أورام السبيل البولي العلوي