Introduction: In 1814 Irish surgeon Abraham Coll first introduced distal radial bone fracture in clinical practice as a colles fracture. It is one of the most common fractures account for 10-20% of the total respectively fracture. Case of Colles fracture has being increased in the developed country year by year besides the increasing number of elderly patients. Depending on severity displaced of the fracture, management includes closed reduction or surgical procedure. The aim of study was to study result of risk factors that influence the closed reduction management of the Colles fracture. Materials and Methods: From hospital based population 80 patients aged between 5-76 years (mean age 47.31 years, male 61.25%, female 38.7%) were recruited by cross sectional and randomized method. Participants were divided into displaced and non-displaced groups which confirmed by refractive index difference on X-ray. Results: The risk factors that influence the colles fracture closed reduction management was osteoporosis (p=0.38), menopause (r=0.18, p=0.27), calcium supplement intake (r=0.21, p=0.05), received hospital care in 24 hour (p=0.39), apply plaster (p=0.64), hand sling immobilizer brace (p=0.5) and physical therapy (p=0.5). Conclusion: Osteoporosis and menopause were the risk factors that influenced the closed reduction management of Colles fracture. The patient cases that not receiving emergency medical care in first 24 hours, not applying plaster, not using the hand sling immobilizer brace and not receiving physical therapy was risk factors for extending the closed reduction management of the Colles fracture.

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.

The timing and technique for palatoplasty is very controversial, recent literature advocates for early repair, between six and eighteen months of age, facilitating normal speech and language development, and avoiding hearing loss. It is using three main kinds of techniques for palatoplasty in the worldwide, two flap pushback, Furlow double opposing z-plasty, and two-step palatoplasty.Cases presenting later in life to the Mongolian National Center for Maternal and Child Healthprovide Mongolian surgeons′ with the challenge of wider defects which are difficult to manage successfully using traditional palatoplasty techniques.Oro-nasal fistula formation is an one of most documented postoperative complication, and it`s rate is reported between 6-42,3% in the literature. In Mongolia patients often present in older than recommended age for palatoplasty,it provide surgeons with the challenge of managing wider defects, which have higher rates of fistula formation and wound dehiscence. There were 30% of ONF in our practice. So, in 2000 we established new modified Mongolian technique for primary palatoplasty for improved outcomes across all age groups. And ONF rate reduced from 30% to 5.9 % in our department. Objective: To determine velopharyngeal function after primary palatoplasty by Mongolian method in connective with age at repair and cleft type.In our study were included over four year’s old patients, who underwent primary palatoplasty by Mongolian method at the authors` centre. We excluded syndromic cases, and patients who had an oronasal fistula postoperatively, and no cooperation with speech therapist. This study, we use video records of nasopharyngeoscopy to evaluate for cleft lip and palate patient’s velopharyngeal function associated with type of clefts, the timing of palate repair and cooperation with speech therapist.There were included totally 28 patients who are 4-23 years old (mean age 10.2 years) at the time of study, were performed primary cleft palate repair by Mongolian technique at NCMCH. The mean age at palate repair was 38 months (14 months-18 years). Overall, 39.2% (11) of patients were performed palate repair at 18≥ months old and 60.8% (17) patients were operated palate repair at 18< months. In the first group, VPI was demonstrated 27,3%, and in the second group 41,2%. Also, there were demonstrated VPI for 66,7% of Veau 1 type, 45,5% of Veau 3 type, and only 10% of Veau 4 type, after Mongolian method. Better velopharyngeal result for Veau 4 type and wide cleft palate after Mongolian method than other types. We should continue this study in wider screen for recognition this results.

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: In 1814 Irish surgeonAbraham Coll first introduced distal radialbone fracture in clinical practice as a collesfracture. It is one of the most commonfractures account for 10-20% of the totalrespectively fracture. Case of Colles fracturehas being increased in the developed countryyear by year besides the increasing numberof elderly patients. Depending on severitydisplaced of the fracture, managementincludes closed reduction or surgicalprocedure. The aim of study was to studyresult of risk factors that influence theclosed reduction management of the Collesfracture.Materials and Methods: From hospitalbased population 80 patients aged between5-76 years (mean age 47.31 years, male61.25%, female 38.7%) were recruited bycross sectional and randomized method.Participants were divided into displaced andnon-displaced groups which confirmed byrefractive index difference on X-ray.Results: The risk factors that influence thecolles fracture closed reduction managementwas osteoporosis (p=0.38), menopause(r=0.18, p=0.27), calcium supplement intake(r=0.21, p=0.05), received hospital care in24 hour (p=0.39), apply plaster (p=0.64),hand sling immobilizer brace (p=0.5) andphysical therapy (p=0.5).Conclusion: Osteoporosis and menopausewere the risk factors that influenced theclosed reduction management of Collesfracture. The patient cases that not receivingemergency medical care in first 24 hours,not applying plaster, not using the hand slingimmobilizer brace and not receiving physicaltherapy was risk factors for extending theclosed reduction management of the Collesfracture.

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.

Introduction. Cancer of unknown primary (CUP) is histologically defined as the presence of a metastasis of lymph node without detection of the primary tumor [1]. Approximately 3–15% of all cancers are designated as CUP [3. 4]. The diagnosis, treatment and monitoring of patients with laterocervical metastases of unknown primary involves a wide range of oncologic entities [5]. While we were studying patho-histological examination of cervical lymphadenopathy in Mongolian, werevealed unknown primary tumor. This is a goal of our study. Objectives of study are followings to differentiate whether primary lymphoma or metastatic cancer of cervical lymph node metastasis of unknown primary tumor and to reveal primitive origin of tumor using by basic and additional immunohistochemical markers.Goal.To determine the conclusive diagnosis in cervical lymph node metastasis of unknown primary origin by immunohistochemical techniqueMaterials and Methods. In this study, we examined immunohistochemically 30 cases of outpatient head and neck surgical unit of the National Cancer Center and dentistry and oral maxillofacial surgical unit of the State Central Hospital which were diagnosed as cervical lymphadenopathy. For immunohistochemical study, we applied an immunohistochemical panel in accordance with avidinbiotin- peroxidase complex method and used a basic and additional antibodies represented by CK(pancytokeratin), LCA, synaptophysin, chromogranin and HMB45. Result. In our study, there was 63.3% lymphoma, 36.7% metastatic cancer. Among them, there were 4 of digestive tract adenocarcinoma, 3 of squamous cell carcinoma /2-esophagus, 1-nasopharyngeal/, 2 of neuroendocrine tumor and 1 of melanoma.Distribution by age groups shows that 20-29 years were 4(13.3%), 30-39 years were 10 (33.3%), 40-49 years were 8 (26.7%), 50-59 years were 3 (10%), over60 years were 5 (16.7%). Gender distribution showed an increased incidence of males (56.7%, 17 cases) compared with females (43.3%, 13 cases).Conclusion: In our study, B cell lymphoma and digestive tract adenocarcinoma were the most common. In further, it is necessary to introduce an immunohistochemical method in patho-histological practice.

To evaluate the efficacy and safety of bevacizumab monotherapy or combined with laser versus laser monotherapy in Mongolian patients with visual impairment due to diabetic macular edema.Prospective, randomized, single-center, a 12 month, laser-controlled, clinical trial. Participants: One hundred twelve eligible patients, aged ≥18 years, with type 1 or 2 diabetes mellitus and best corrected visual acuity (BCVA) in the study eye of 35 to 69 Early Treatment Diabetic Retinopathy Study (ETDRS)letters at 4 m (Snellen equivalent: ≥6/60 or ≤6/12), with visual impairment due to center-involved diabetic macular edema (DME). Methods: Patients were randomized into three treatment groups:(I) intravitreal bevacizumab monotherapy (n=42), (II) intravitreal bevacizumab combined with laser (n=35), (III) laser monotherapy (n=35). Bevacizumab injections were given for 3 initial monthly doses and then pro re nata (PRN) thereafter based on BCVA stability and DME progression. The primary efficacy endpoints were the mean change in BCVA and central retinal subfield thickness (CRST) from baseline to month 12.Bevacizumab monotherapy or combined with laser were superior to laser monotherapy in improving mean change in BCVA letter score from baseline to month 12 (+8.3 and +11.3 vs +1.1 letters; both p<0.0001). There were significant difference detected between the bevacizumab and bevacizumab combined with laser treatment groups (p=0.004). At month 12, greater proportion of patients gained ≥10 and ≥15 letters and with BCVA letter score >73 (Snellen equivalent: >6/12) with bevacizumab monotherapy (23.8% and 7.1% and 4.8%, respectively) and bevacizumab + laser (57.1% and 28.6% and 14.3%, respectively) versus laser monotherapy. The mean central retinal subfield thickness was significantly reduced from baseline to month 12 with bevacizumab (−124.4 μm) and bevacizumab + laser (−129.0 μm) versus laser (−62.0 μm; both p<0.0001). Conjunctival hemorrhage was the most common ocular events. No endophthalmitis cases occurred.Bevacizumab monotherapy or combined with laser showed superior BCVA improvements over macular laser treatment alone in Mongolian patients with visual impairment due to diabetic macular edema.

: 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