Background: Hypospadias is a common congenital anomaly affecting the penis in which the opening of the urethra is on the ventral surface of the penis, usually associated with ventral curvature of penis (chordae). Treating hypospadias is a challenging mission for the surgeons. Many techniques have been descried in the literature for the repair of hypospadias with variable results. Objectives: To evaluate the surgical and cosmetic outcome of distal hypospadias repair including different procedures used to repair distal hypospadias and to identify complications and suggest solutions.

Background: Sentinel lymph node (SLN) biopsy has been emerged as safe and accurate procedure for axillary staging in breast cancer and to direct the need for further axillary treatment in patients with early breast cancer. Objectives: To assess the status of axillaries lymph nodes in patients of breast cancer to determine further management of the axilla and to assess status of non sentinel lymph nodes cases of negative SLN. Patients and methods: It is prospective interventional study done in Omdurman Teaching Hospital, department of General Surgery from 27/6/2012 to 30/8/2013 in patients underwent modified radical mastectomy plus level I and II axillaries clearance by injecting methylene blue dye and identifying sentinel lymph node in patients diagnosed with breast cancer. Results: Total number of 39 female patients under went modified radical mastectomy and level 1 and II axillaries clearances, In 22 patients 56.4% the retrieved sentinel axillary lymph node proved histopathologically to contain malignant cells. In eight patients 20.5% the sentinel lymph node were negative for malignancy and in 09 (23.1%) the SLN was either not found or reactive, Non-sentinel lymph node (NSLN) was found to be positive for malignancy in 11 (28.2%) of the cases. In 23 (59.0%) it was negative and in 05 (12.8%) it was not found. Out of 22 patients with positive SLN, half of them 11 patients were concomitantly had a positive NSLNs and the other half had a negative NSLN. In the eight patients with negative SLN for malignancy, all of them 08 (100%) had their NSLNs as well were negative for malignancy. These relations were found statistically to be highly significant (P value 0.000) none of the patients in study diagnosis as positive NSLN in negative SLN base. Conclusion: Highly occurrence of positive NSLN in patient diagnosis by T3 and T4 in the study, a number of patients diagnosis by positive NSLN in positive SLN was 32, 4 %, none of the patients in study diagnosis by positive NSLN in n

Introduction: Intestinal atresia is a common cause of neonatal intestinal obstruction. Duodenal atresia occurs most properly due to failure of recanalization of the foregut, while jejuno-ileal atresia is due to intra uterine ischemia. Objectives: To describe the pattern, clinical presentation, surgical treatment and outcome of bowel atresia. Patients & Method: The study was Observational, analytic, hospital based study. Result: Study of 40 patients with small bowel atresia showed that; more than 80% of patients were neonates, males: females’ ratio was 1.4:1. Duodenal atresia was found in 27.5 % while jejunoileal atresia was found in 82.5% (57.5% was jejunal and 15% was ileal). All patients presented with vomiting most of them were bilious. Features of Dawn syndrome reported in four patients, all of them were duodenal (36%), cardiac anomalies occurred in 18% of duodenal atresia. Malrotation was found in three patients one was duodenal and two were jejunoileal. Prematurity occurred in 20% of patients, low birth weight was found in 45%. Duodenal atresia was treated by duodenoduodenostomy, duodeno-jejunostomy or duodenotomy for stenosis. While jejunoileal atresia was treated resection and anastomosis in most of the cases, enteroplasty was done in patients with short bowel, one patient treated by stoma because of perforation and peritonitis. Mortality rate was 32.5% due to multiple causes; cardiac anomalies, jaundice, prematurity and type of atresia were the commonest causes. Conclusion: In our country lack of neonatal intensive care unit and total parenteral nutrition increases the mortality rate, availability of these things plus pre natal diagnosis will improve the outcome.

Aim to evaluate the amplitude of MHI received by OTH. This prospective descriptive cross sectional hospital base study carried out in a single plastic surgery unit at OTH in the period from sep 2012- sep2013. A total of 106 MH injured patients were enrolled in this study; Evaluation is purely clinical and radiological. Initial management included general assessment of the patient status, wash of the wound with antiseptic, careful limited initial debridement, elevation of the hand, antibiotic and anti tetanus prophylaxis. Beside exploration of the wound with proper surgical management according to the injury ranging from minimal stitching, V.Y flap, skin graft, vessel, nerve, tendon repair to bone fixation .with severely crushed hand a limited stitching and waiting for 48 h before a second look. The study revealed that the right hand dominance was prevalent in 97.2% and was the most affected (64.1% ). The mean age of the study group 25 years with male to female ratio of 4:1. Among named machines, Grinder injury is the commonest represent about (36.8%); followed by plastic machine 8.7%. The most involve part of the hand is the middle finger 14.2% , index 10.4% and thumb 8.5% .Highest percentage of fractures found in the middle finger 15.1% . Skin loss was seen mainly in index finger 4.7%. Concerning the management at tertiary hospital, minimal stitching constitutes 55.7% followed by V.Y flap 7.5%. Amputation in MHI is of great significance of P- value < 0.03, at initial discharge from ER; thumb represent (2.8%), and index (4.7)% Conclusion : Severe hand injury in form of finger amputation, skin loss, nerve and arterial injuries are more common in age below 25 years. Grinder and plastic machines are the commonest cause of MHI among named machines

We make a comparative study of Multifractal Detrended Fluctuation Analysis(MF-DFA) and the Wavelet Transform Modulus Maxima (WTMM) method todetect multifractal character of natural gas daily returns. We give a briefintroduction on above methods and compare their effectiveness. The results fromthis methodoligies show that behaviour of natural gas daily returns weremultifractal. The major sources of multifractality are long-range correlations ofsmall and large fluctuations andFat-tail distributions of the series.

Background: The incidence of coronary artery disease (CAD) is rising in Sudan as well as in Africa and all over the world, with increasing need for myocardial revascularization. This study is an attempt to highlight the safety of practicing off- pump coronary artery bypass grafting as a primary option for surgical myocardial revascularization, as the use of cardiopulmonary bypass machine was found to be associated with many cardiovascular and systemic complications. Lacking local information regarding this operation dedicated the need to structure such a research in order to be a basis for further studies. Objective: To assess the preoperative characteristics and outcome of patients undergoing off-pump coronary artery bypass surgery. Method: This is a combined retro-prospective descriptive consecutive case series study conducted at Sudan Heart Institute (SHI) and included all the patients with CAD; who were candidates for CABG; presented in the period between Aug/2011 to Aug/2013 Results: 91 patients were included in this study. Females (30.8%) were less affected compared to males and the most affected age group was 41-69 years. 63.7% had HTN, 52.7% had DM. The majority (76.9%) presented with angina CCS class III or VI. Significant LM coronary artery disease was detected in 38 (41.8%). None of the patients had post operative MI. 10 (11.0%) patients developed atrial fibrillation. 56 (61.5%) were extubated within the first 6 hours and 61 (67%) needed primary ICU care for one or 2 days. One death (1.1%) was reported during 30 days- postoperative follow up. Conclusion: Off-pump coronary artery bypass grafting could be conducted safely in SHI with reasonable outcome compared to the international data.

Background : Paediatric trauma is expected by the WHO to be the number one disease globally in 2020. Although the abdomen is the third most commonly injured anatomic region in children following the head and extremities, blunt abdominal trauma is the most common cause of initially unrecognized fatal injuries. Objectives : To study mechanisms of injury, presentation, management and outcome of paediatrcis blunt abdominal trauma in KTH. Patients and methods: This is a prospective observational descriptive study involving children aged less than 15 years presenting to KTH with blunt abdominal trauma. The study conducted in the period from March 2012 to August 2013. Results: There were 50 patients. The mean age was 7 years. Male to female ratio was 2:1. There was a wide spectrum of causative trauma. The most frequent cause was RTA 40% .Solid organ injuries were (70%), intestinal injuries (12%), diaphragmatic hernia (2%), abdominal wall haematoma (2%), NOM for solid organs injuries was successful in 94%. There were 3 deaths (6%). Two of them associated with head injuries and one was delayed intestinal perforation. Conclusion: The majority of children with blunt abdominal solid organs injuries can be treated successfully without surgery, associated head injuries and delayed intestinal perforation were main causes of mortality.

Background : Haemorrhoidectomy is a commonest anal surgical procedure which is usually associated with post operative pain, Stapled Haemorrhoidopexy (SH) is a new alternative to conventional haemorrhoidectomy (CH). It was first described by Dr. Antonio Longo, in 1998 and since then it has been widely adopted, and can be used in the management of 2nd, 3rd and 4th degree hemorrhoids. Objective : To study (SH) in Sudan and to evaluate its effectiveness in the treatment of haemorrhoids. Patients and Methods : It is a retro-prospective descriptive study. Conducted at multicentres (7 hospitals) in the period from 2009 January to 2013 August. It included all Cases of 2nd, 3rd and 4th degree haemorrhoids underwent (SH) procedure. Data regarding the clinical presentation, duration of the surgery, postoperative complications, duration of hospital stay and period of retaining to normality were reviewed and analyzed using (SPSS) .The mean follow up duration was 28 months. Results : The study included 100 patients, 80 men and 20 women (23 – 85) years with mean age (42.2years ± SD 14.2). Male to female ratio was 4:1.This male gender preponderance was found to be statistically significant (P value 0.007) The most frequent symptoms either alone or in combination with other symptoms were pain 83%, swelling/prolapse 57% or bleeding 64%. Third degree haemorrhoid represents 56% of the patients, 4th degree haemorrhoid in 34% and 10% had second degree who were not respond to conservative management. The mean duration of surgery was (35.6 minutes ± SD 19.4) and ranged between (15 -120) min. The immediate post-operative pain was experience by 68 patients 68% and assessed by Visual Analogue Scale, mild to moderate pain in 53% of the patients and the pain fade by day three post-operative in 89%. Minor post-operative complications were seen in 66 patients. In more than half of them it was pain with or without defecation 45%, bleeding in 8%, urine retention in 6%. During the follow up whic

Background: Iatrogenic biliary duct injury is a rare but potentially devastating condition associated with significant morbidity and mortality. Related data are limited in developing countries. This study aimed to analyse the clinical presentation, diagnosing and type of biliary injuries, and management proposed and in a population treated at a tertiary care centre. Method : Retrospective and prospective analysis of patients who sustained IBDI, and presented to the Gastroeneterology surgical department at the National Centre Of Gastroenterolgy and Liver Disease Sudan , between the period of October 2010 to September 2013 (three years period). Results : Total of 40 patients diagnosed as IBDI, 36 were females and 4 were males. Their mean age was 41 years (range 23-72) years. IBDI were due to 90% (n=36) post OC and due to10% (n= 4 ) post LC. 65%presented with obstructive jaundice, 20% presented with biliary peritonitis, 15% presented with biliary cutaneous fistula (bile leak). The identification rate of intra-operative injury was 10% and 90% in the post-operative group. Time of presentation ranged between 2 days and 3 years the median was12 days .According to Strasberg type E I, II, III and type D injuries, 20%, 37.5%,35%,7.5% were seen in patients, respectively. 87.5% of patients (n=35) underwent Roux en Y HJ. 5% of patients (n=2) underwent ERCP stenting, 2.5% underwent end to end anastamosis , 2.5% underwent primary repair T tube insertion.. Fifteen patients (40.5%) had complications during their hospital stay. Total hospitalization days, ranged between 14 days and 1months the median was 18 days. Mortality was 12.5% (n=5). Conclusion : Open cholecystectomy is the main cause of IBDI in our study. In most of the cases surgical reconstruction with hepaticojejunostomy was required as the definitive treatment. ERCP should only be attempted when there is biliary continuity Intrabdominal abscess is the most common cause of death. Early referral to a tertiary centre with exp

The problem of estimating Doppler shifts and delays of signals modulated by pseudorandom sequences is discussed. It is shown that signals reflected from slow-moving targets hidden among optically opaque wreckages contain some information on targets in the variations of the full phase of a signal over the period that exceeds considerably the pseudorandom oscillation period. For example, these variations in the full phase may result from breathing and heartbeat of those who survived after man-made or natural disasters. Non-correlated and correlated types of noise lead to the errors in a thin structure of code sequences. In this paper a quasi-optimal receiver with non-coherent discriminators is proposed. The receiver has the two parallel channels which are synchronized by phase with a sounding signal. The receiver synthesis procedure, its operating conditions and its characteristics are fully considered. The synthesis is based on the modified non-linear filtering methods. This theory has been used to build the signal processing algorithm. The synthesis procedure consists of two steps. At the first step we assume that signal frequency has no shift and the base structure of the signal processing algorithm has been obtained. At the second step we assume that the structure of the algorithm remains unchanged, and using the theory of signal filtering the filter in the control loop for shifted frequencies is designed. In is shown that the sequences of combined estimates of the frequencies shifts and the signal delay can be used as a model of a dynamic Kalman filter. Fig.: 3. Ref.: 18 pos.