Introduction: In gallstone diseases, common bile duct stones and thickened bile could cause hepatitis or other difficulties. Therefore intraoperative cholangiography is helpful in many operations besides detecting and diagnosing the gallstones in common bile duct. Materials and Methods: Out of 266 patients who had undergone Laparoscopic Cholecystectomy surgery in GrandMed Hospital, 14 patients were found to have jaundice and cholestasis after undergoing laboratory and radiology tests. Results: These 14 patients have all undergone IOC. 7 out of 14 patients were found to have positive cholangiogram and the other 7 - negative. Biliary tract tumor and anatomic anomalies were not identified among these patients. Conclusion: Making analysis using only laboratory data is not adequate for directly detecting choledocholithiasis. IOC not only shows bile tract obstruction and determines cholestasis causes, but it also identifies the anatomy biliary tract, which is a procedure that facilitates dissection. Therefore IOCcan prevent the most serious complication of laparoscopic cholecystectomy - common bile duct injury. The sensitivity of IOC ensures the gathering of important information on time, so suggest to use it for every suspicious case.

Introduction: In gallstone diseases,common bile duct stones and thickened bilecould cause hepatitis or other difficulties.Therefore intraoperative cholangiography ishelpful in many operations besides detectingand diagnosing the gallstones in commonbile duct.Materials and Methods: Out of 266patients who had undergone LaparoscopicCholecystectomy surgery in GrandMedHospital, 14 patients were found to havejaundice and cholestasis after undergoinglaboratory and radiology tests.Results: These 14 patients have allundergone IOC. 7 out of 14 patients werefound to have positive cholangiogram andthe other 7 - negative. Biliary tract tumorand anatomic anomalies were not identifiedamong these patients.Conclusion: Making analysis usingonly laboratory data is not adequate fordirectly detecting choledocholithiasis. IOCnot only shows bile tract obstruction anddetermines cholestasis causes, but it alsoidentifies the anatomy biliary tract, whichis a procedure that facilitates dissection.Therefore IOCcan prevent the most seriouscomplication of laparoscopic cholecystectomy- common bile duct injury. The sensitivityof IOC ensures the gathering of importantinformation on time, so suggest to use it forevery suspicious case.

Summery For TDHDiaphragmatic rupture is a lifethreateningcondition. Diaphragmaticinjuries are quite uncommon and oftenresult from either blunt or penetratingtrauma. Diaphragmatic ruptures are usuallyassociated with abdominal trauma however,it can occur in isolation. Acute traumaticrupture of the diaphragm may go unnoticedand there is often a delay between the injuryand the diagnosis. A comprehensive literaturesearch was performed using the terms“delayed presentation of post traumaticdiaphragmatic rupture” and “delayeddiaphragmatic rupture”. The diagnosticand management challenges encounteredare discussed, together with strategies fordealing with them.In our hospital, we had one patientwho has been diagnosed as a TDH. Wewerefocused on mechanism of injury,duration, presentation and site of injury,visceral herniation, investigations anddifferent approaches for repair. We intendto do a laparoscopic repair, but it diagnosedas a TDH so we did open Laparotomy.

Introduction: Various modalities oftechniques from standard discectomy,microdiscectomy, percutaneous discectomy,and transforaminal endoscopic discectomyhave been in use for lumbar intervertebraldisc prolapse1. The access to spine is keptto a minimum without stripping paraspinalmuscles minimizing muscle damage bytransforaminal endoscopic approach2.Currently in the population of the Mongoliabeen increased of the spinal nerve rootcompression, which are resulting in lumbardisc pathological changes. In other developedcountries has been successfully introducingthe spine endoscopic surgery use for thatpathological changes. In regard to our countryhad not yet implemented for until now asthese high technological surgeries3. Spinesurgery department team of the GrandMedhospital had successfully introduced that thespine endoscopic surgery.Materials and Methods: We performedtransforaminal endoscopic lumbardiscectomy surgeries on patients age of 24,38, 78 on July/23/2016 All patients withsingle nerve root compression due to Lumbardisc herniations, including sequestrated ormigrated and selected central disc at L4-5. All patients had preoperative MRI andpostoperative MRI to check the adequacy ofdecompression. All patients were operatedby 18-mm ports of the S-Gun endoscopicequipments. Procedure had done under localanesthesia. Postoperatively, all patients weremobilized as soon as the pain subsided anddischarged within 24-48 h post-surgery.Patients were followed up at 2, 6 weeks.Results: The mean follow up was 2-6weeks. The average surgical time was 70min (range 25-210 min). Average blood losswas 20-30 ml. Postoperative MRI showedcomplete decompression. All of patients hadgood-to-excellent results and straight raisingleg test (Lasegue) were 90/90 respectively.All patient is preoperatively visual analogyscale was 8±1 and then became to 1±1.Conclusion: Microendoscopic discectomyis minimally invasive procedure fordiscectomy with results of this procedure areacceptable safe and effective. However, forthis technique has required to do accuracyand experienced surgeon.

: BACKGROUND: The Mongolian National drug policy states, “The rational drug rehabilitation is one of the main goals of pharmaceutical care”. Recruitment and prescription medications are important issues for improving rational use of medicines. According to the recommendations of the World Health Organization (WHO), the status of rational use of medicines is assessed through the recipe by 10 criteria. The needs to study on rational drug use in hospitals of Ulaanbaatar and determining standard criteria for the proper use of drugs by recommendation of World Health Organization is the main justified issue of the study. METHODS: In order to study the rational use of medicines, a single moment /descriptive/ research type was used. Recipes for 50 and 50 people who received prescription from pharmacy within 12 hospitals TFCHM, TSCHM, TTCHM, NCCD, NTaORC, NCMH, HCSKhD, HCChD, HCSBD, HCKhUD, HCBZD, HCBGD June 2017 in Ulaanbaatar, it was based on the WHO recommended methodology, a total of 600 clients, 600 recipes and 1249 medicines were selected and submitted to the conclusions. RESULTS: The average number of medicines per minute was 2.08 ± 0.25, 45.2% in International Health Prescription were 42.6% antibiotics. According to a study on a contingency test, 85% did not have prescription signs, 38.8% without diagnostic prescription, 25% did not have physicians, and 48% did not have any medical information. The knowledge about the dose was 68.5% . CONCLUSION The results of the study were compared with the recommendations of the World Health Organization and the proportion of medicines included in the ICS list was lower than the recommendations of the World Health Organization list and the proportion of antibiotic drugs. The study found that 11 different incidents were encountered. Knowledge about medicines dose was 68.5%, compared to World Health Organization recommendations

ABSTRACT. Recurrent aphthous stomatitis, or RAS, is common oral disorder of uncertain etiopathogenesis for which only symptomatic therapy is available. This article reviews the current clinical features of RAS among study patients and the result of therapeutic effects of the herbal preparation Akhizunber. Over the past four years we have treated 61 RAS patients with different clinical forms by herbal preparation Akhizunber or Alumekatin. The distribution of clinical forms RAS RAS among study patients were minor aphthae -75.4%, major aphthae -16.4% and herpetiform ulcers -8.2% respectively. The healing time of treated Akhizunber was in minor aphthae -9.28±4.82 days, major aphthae -14 days and herpetiform ulcers -12 days. Of the total study participants, the patients treated by Akhizunber reported a rapid and complete recovery from RAS during treatment compared with treated patients by Alumekatin. Treatment with herbal preparation Akhizunber can be effective for patients suffering from RAS in any clinic form, regardless of their ulcer number and size.