Hemicraniectomy with dural augmentation in medically uncontrollable hemispheric infarction

1997 ◽  
Vol 2 (5) ◽  
pp. E7 ◽  
Author(s):  
Christian Rainer Wirtz ◽  
Thorsten Steiner ◽  
Alfred Aschoff ◽  
Stefan Schwab ◽  
Holger Schnippering ◽  
...  
Keyword(s):  
Survival Rate ◽  
Surgical Intervention ◽  
Vegetative State ◽  
Surgical Decompression ◽  
Middle Fossa ◽  
The Past ◽  
Small Series ◽  
Significant Difference ◽  
The Mean ◽  
Hemispheric Infarction

Surgical decompression to alleviate raised intracranial pressure has been reported repeatedly in the past decades in small series of patients. Only recently have there been indications from larger trials that surgical decompression may be beneficial in treating space-occupying hemispheric infarction. However, surgical requirements for the procedure to be effective have not yet been defined. Based on theoretical criteria, the authors operated on 43 patients with medically uncontrollable hemispheric infarctions. The craniectomies were planned to be as large as possible and performed in combination with a subtemporal decompression. Postoperative computerized tomography scans were evaluated for these criteria. The mean survival rate for the group of 43 patients was 72.1% and no surviving patient ended up in a vegetative state. The mean area of craniectomy was found to be 84.3 ± 16.5 cm2 and the mean distance of the inferior craniectomy margin to the middle fossa was 1.8 ± 1.3 cm. Comparison of survivors and nonsurvivors failed to show a significant difference in the size of craniectomy or the distance to the floor of the middle fossa. Compared with the reported 80% fatality rate for medically treated stroke patients, in this subgroup the outcome (72.1% survival rate) is remarkably good. The authors conclude that decompressive craniectomy is an effective treatment, able to reduce mortality, and to improve neurological outcome in patients with space-occupying cerebral infarction if the size of craniectomy is large enough. Nevertheless, there is a need for further investigation to identify patients who will benefit from surgery and predictors to optimize the timing of surgical intervention.

scholarly journals SUN-136 Clinico-Pathological Features, Treatment Modalities and Survival of Patients with Malignant Insulinoma: A Multicenter Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Alessio Veltroni ◽  
Elisa Cosaro ◽  
Sara Cingarlini ◽  
Maria Chiara Zatelli ◽  
Grossrubatscher Erika Maria ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Survival Rate ◽  
Primary Tumour ◽  
Diagnostic Delay ◽  
Treatment Modalities ◽  
Ki 67 ◽  
Malignant Insulinoma ◽  
Small Series ◽  
Significant Difference ◽  
The Mean

Abstract Introduction: management of malignant insulinoma is challenging due to the need to control both hypoglycemic syndrome and tumor growth. Literature data is limited to small series. Aim of the study: to analyze clinical-pathological characteristics, treatment modalities and prognosis of patients with malignant insulinoma. Materials and methods: Multicenter retrospective study on 31 patients (M 61.3%) diagnosed between 1988 and 2017. Results: The mean age at diagnosis was 48 ± 15 years. In 5 cases (16.1%) the hypoglycemic syndrome occurred after 46 ± 35 months from the diagnosis of NET, in 26 (83.9%) cases it led to the diagnosis of NET, of which 11 cases (42.3%) with mean diagnostic delay of 32.7 ± 39.8 months. The majority ​​of the NET were G2 (70.8 %) and in the pancreatic body-tail (78.6%). The mean NET diameter was 41 ± 31 mm. Metastases were widespread in 40.7%, only hepatic in 37%, only lymph nodal in 18.5%..Surgical treatment was performed in 21/31 (67.7%) with hypoglycemic control in 42.9%. Except for 2 patients with curative surgery, the others underwent further different lines of therapies including somatostatin analogues (SA), Peptide Receptor Radionuclide Therapy (PRRT), everolimus, chemotherapy, TAE/TACE/RFA, radiotherapy. PRRT was performed in 14/31 (45.1%) with complete (42.9 %) or partial (50%) syndrome control. The median follow-up was 60 months. The 5-year survival rate was 62%. The median overall survival (OS) was 40 months. No significant difference in OS was observed according to the site of primary tumour and its dimension. A trend towards increased survival was found according to grading (5-year OS 100% for G1, 77% for G2, 33% for G3). Patients with Ki-67 ≤ 10% had a significant higher survival rate compared to patient with Ki-67 >10% (5-year OS rate 87% vs 43%, p: 0.03). As regards the type of treatment, patients who underwent surgery had a higher survival rate than those who did not (5-year OS 76% vs 31.7%, p= 0.006). Moreover, patients receiving PRRT as II line treatment had a better prognosis than those who underwent it in further lines, although the 5-year OS was not significantly different (80% vs 25% respectively, p=0.057). Conclusions: Our study includes the largest series of patients with malignant insulinomas up to now reported. The hypoglycemic syndrome may occur after years in initially non-functioning NETs, or be misunderstood with delayed diagnosis of NETs. Surgical treatment and Ki67 <10% are prognostic factors associated with better survival. PPRT seems to be promising in the control of hypoglycemic syndrome.

scholarly journals Assessment of productivity of pangas catfish (Pangasius pangasius, Hamilton-1822) culture in jute retting pond in Murshidabad district

2021 ◽  
Vol 17 (2) ◽  
pp. 328-334
Author(s):  
Samiran Patra ◽  
Uttam Roy
Keyword(s):  
Survival Rate ◽  
West Bengal ◽  
Disease Incidence ◽  
Stocking Density ◽  
Water Parameters ◽  
Significant Difference ◽  
Final Weight ◽  
Water Ph ◽  
Final Length ◽  
The Mean

Murshidabad district is the highest jute producer district in West Bengal where maximum numbers of ponds beels, canals and irrigational channels are being used for jute retting from July to September and after retting, water bodies remain uncultured. But few farmer’s, they were culture traditionally with IMC and exotic carps and getting very low yield (3.66q ha-1yr-1). In that condition Murshidabad KVK has designed one OFT trails having three treatments, Farmer’s Practice (FP), Technology Option-I (TO-I) and Technology Option-II (TO-II) on air-breathing fish pangas (Pangasius pangasius) and conducted in farmers’ field for three years. To find out the suitable fish species, observed water parameters (pH, DO mg L-1), stocking density (nos./ha), length (cm), weight (g), survival rate (%), yield (q ha-1yr-1), cost of culture (Rs. ha-1yr-1) gross return (Rs. ha-1yr-1), net return (Rs. ha-1yr-1), BC ratio and disease incidence etc. The effect of water pH and DO (mg L-1) in post jute retting pond and fish stocking pond indicate, there were a statistically significant difference between three treatments at (p <.05). Stocking density in three treatments were 15000 nos. ha-1 (IMC and exotic carps), 11250 nos. ha-1 and 15000 nos. ha-1 (pangas, size 2.5”) . In this trial it was observed that the mean (SD) initial length (cm), initial weight (g) and final length (cm) were not statistically significant at p >.05 but in case of final weight (g) and weight gain (g) there were statistically significant at p<.05. The survival rate (%) was lowest in FP (35.04±4.51) and highest in TO-I (67.55±17.50) and not statistically significant (p >.05). The mean (SD) yield (q ha-1yr-1) was high statistically significant difference found among three treatments (p <001). The average net profits were Rs.65680.0, Rs. 223841.0 and Rs. 337551.0 ha-1 yr-1. in FP, TO-I and TO-II, respectively. The highest mean B:C ratio was 2.44 in TO-II. With the all concerned it was observed TO-II gives the best result among these three treatments in these three years trials.

scholarly journals A Study of Clinical Profile of Intracerebral Hemorrhage and ENT Manifestations and its Surgical Outcome

2017 ◽  
Vol 8 (1) ◽  
pp. 5-10
Author(s):  
Vishwanath Sidram ◽  
PC Chandra Kumar ◽  
Bellara Raghavendra
Keyword(s):  
Intracerebral Hemorrhage ◽  
Surgical Outcome ◽  
Vegetative State ◽  
Clinical Profile ◽  
Outcome Variable ◽  
Significant Difference ◽  
Common Causes ◽  
The Mean ◽  
Time Of Presentation ◽  
Head Neck

ABSTRACT Introduction The aim of this study is to study the clinical profile and outcome of primary and secondary intracerebral hemorrhage (ICH) and to study the different parameters that affect the outcome. Materials and methods A total of 40 patients who were diagnosed to have ICH, both primary and secondary, by computed tomography scan were included in the study. Among the selected patients, the clinical profile, radiological profile, and the modality of treatment undertaken and the outcome were noted. Outcome variables included survived [improvement in the Glasgow Coma Scale (GCS)], death, and vegetative state. The outcome variable was compared with respect to age, sex, GCS, etiology, location of the hematoma, and the modality of treatment to find out any statistically significant difference in the rate of outcomes. Results The mean age of the patients was 36.78 ± 18.5 years; mean GCS at the time of presentation was 9.05 ± 1.82. Common causes of ICH were trauma (57.5%) and hypertension (25%). Significant association was found between outcome and age group, GCS, etiology of ICH, and location of the bleed. Poor outcome was associated with GCS ≤ 8 (40%), >50 years of age (45.5%), hypertension (50%), and basal ganglia bleed (50%). Best outcome was seen in patients with GCS ≥9, a lobar bleed, and trauma as the cause of ICH where the patient survival was 90%. Conclusion In case of ICH depending upon the clinical and radiological profile, the treatment should be individualized. The rates of survival and favorable outcome are better in patients with GCS ≥ 9, a lobar bleed, and trauma as the cause of ICH. How to cite this article Sidram V, Kumar PCC, Raghavendra B. A Study of Clinical Profile of Intracerebral Hemorrhage and ENT Manifestations and its Surgical Outcome. Int J Head Neck Surg 2017;8(1):5-10.

Long-term Follow-up Results of Buechel-Pappas Ankle Arthroplasty

2019 ◽  
Vol 40 (5) ◽  
pp. 553-561 ◽  
Author(s):  
Sajeeban Krishnapillai ◽  
Boudijn Joling ◽  
Inger N. Sierevelt ◽  
Gino M.M.J. Kerkhoffs ◽  
Daniël Haverkamp ◽  
...  
Keyword(s):  
Survival Rate ◽  
Functional Outcomes ◽  
Joint Disease ◽  
Foot And Ankle ◽  
Inflammatory Joint Disease ◽  
Sf 36 ◽  
Significant Difference ◽  
The Mean

Background: Total ankle replacement (TAR) is gaining popularity as a treatment option for ankle osteoarthritis. Long-term implant survival is a critical outcome to determine the success of the TAR implant. The Buechel-Pappas (BP) implant is a second-generation mobile bearing implant. The aim of this study was to analyze the BP implant survivorship at 10-year follow-up, make a subanalysis between patient groups, and evaluate long-term functional outcomes. Methods: Data of 86 patients who received 101 BP implants between 1993 and 2010 were obtained from a prospectively documented database. Subanalyses were done for patients diagnosed with inflammatory joint disease and noninflammatory joint disease, and patients with preoperative tibiotalar neutral and nonneutral alignment. A Kaplan-Meier curve was used for survival analysis. Long-term functional outcomes were assessed with the following patient-reported outcome measures: Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), Short Form-36 (SF-36) Stand Version 2.0 Health Survey and 3 anchor questions. Results: The survival rate of the BP implant at 10 years was 86% (95% confidence interval, 78%-93%). A total of 31 patients (36%) required 55 reoperations, and in 13 patients (15%) a revision procedure was performed. In this series, no significant difference in 10-year survival rate was found between neither the inflammatory joint disease and noninflammatory joint disease group ( P = .47), nor the tibiotalar neutral and nonneutral alignment group ( P = .16). At a mean follow-up of 16.8 years for 21 patients, the mean FAOS activities of daily living (ADL) and FAAM ADL subscale scores were 75/100 and 56/100 points. The mean physical component summary (PCS) and mental component summary (MCS) of the SF-36 were 34/100 and 51/100 points, respectively. Conclusion: A survival rate of 86% was found at 10-year follow-up for the Buechel-Pappas implant. Our series demonstrated no significant difference in 10-year survival rates between the 2 patient subgroups. Long-term results of the various functional outcomes varied between poor and moderate. Level of Evidence: Level II, prospective cohort study.

scholarly journals Preoperative and Postoperative PROMIS and FFI Scores Based on Region of Foot Pathology and Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0038
Author(s):  
Charles C. Pitts ◽  
Bradley Alexander ◽  
Elise M. Greco ◽  
Benjamin B. Cage ◽  
Spaulding F. Solar ◽  
...  
Keyword(s):  
Physical Function ◽  
Surgical Intervention ◽  
Activity Limitation ◽  
Foot And Ankle ◽  
Tertiary Referral Center ◽  
Pain Disability ◽  
Ankle Surgery ◽  
Significant Difference ◽  
Patient Reported ◽  
The Mean

Category: Other; Ankle; Ankle Arthritis; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: The Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) has become increasingly utilized in orthopaedic foot and ankle surgery to assess outcomes and better understand patient function, pain, and disability. Similarly, the Foot Function Index (FFI) is used to assess pain, disability, and activity limitation. PROMIS scores have been shown to predict, preoperatively, which patients will benefit most from foot and ankle surgery from a general perspective. It is currently unknown, with regard to chronic foot pathology, which region of the foot has the greatest effect on PROMIS and FFI scores and which region is affected the most by surgical intervention. Methods: PROMIS physical function, pain index, and depression scores along with FFI scoring subsets of pain, disability, and activity limitation were retrospectively reviewed for patients at a tertiary referral center with chronic pathology in either the hindfoot, midfoot, or forefoot that underwent surgery. Scores were obtained preoperatively and at 6 weeks postoperatively, and a preoperative to postoperative difference was calculated. Once the mean of each subcategory was obtained, an analysis of variance (ANOVA) was conducted in order to compare the means and identify statistically significant differences. Significance was set at p < 0.05 and p < 0.10. Results: There was no statistically significant difference between the mean preoperative PROMIS or FFI scores in the forefoot, midfoot, or hindfoot regions. There was also no statistically significant difference between means of PROMIS or FFI categories at 6 weeks postoperatively. However, the mean pre- to postoperative differences between PROMIS physical function scores of the forefoot, midfoot, and hindfoot were statistically significantly different at 9.12, 8.16, and 2.88, respectively (p=0.037). There was no statistically significant difference between the remaining scoring categories. Conclusion: Physical function, pain, depression, disability, and activity limitation are not affected disparately by the location of chronic pathology within the foot. Surgical intervention for problems in the forefoot, midfoot, and hindfoot does not provide differences in outcomes with regard to pain, disability, depression, or activity limitation based on region. Patients who have undergone surgical intervention for forefoot or midfoot pathology may experience greater improvements in physical function postoperatively when compared to patients who have undergone hindfoot surgery. [Table: see text]

scholarly journals No difference of survival between cruciate retaining and substitution designs in high flexion total knee arthroplasty

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Gun-Woo Kim ◽  
Quan He Jin ◽  
Jun-Hyuk Lim ◽  
Eun-Kyoo Song ◽  
Jong-Keun Seon
Keyword(s):  
Survival Rate ◽  
Survival Rates ◽  
Cruciate Retaining ◽  
High Flexion ◽  
Significant Difference ◽  
Ankle Angle ◽  
Total Knee ◽  
The Mean ◽  
Hip Knee Ankle Angle

AbstractThe aim of this study was to compare the long-term implant survival and outcomes in patients with high-flexion cruciate-retaining (CR) or high-flexion posterior cruciate-substituting (PS) knee implants. A total of 253 knees (CR group: 159 vs. PS group: 94) were available for examination over a mean follow-up of 10 years. Clinical outcomes were assessed including the Hospital for Special Surgery score, Knee Society score and Western Ontario and McMaster Universities Osteoarthritis Index score at the final follow-up. Radiologic measurements were also assessed including the hip-knee-ankle angle and radiolucent lines according to the KSS system at the final follow-up. The survival rate was analyzed using the Kaplan–Meier method. At the final follow-up, the mean total HSS scores were similar between the two groups (p = 0.970). The mean hip-knee-ankle angle at the final follow-up was similar between groups (p = 0.601). The 10- and 15-year survival rates were 95.4% and 93.3% in the CR group and 92.7% and 90.9% in the PS group, respectively, with no significant difference. Similar clinical and radiographic outcomes could be achieved with both the high-flexion CR and high-flexion PS total knee designs without a difference in survival rate after a 10-year follow-up.

scholarly journals Quantifying the impact of surgical decompression on quality of life and identification of factors associated with outcomes in patients with symptomatic metastatic spinal cord compression

2020 ◽  
Vol 33 (2) ◽  
pp. 237-244
Author(s):  
Asad M. Lak ◽  
Amina Rahimi ◽  
Abdullah M. Abunimer ◽  
Ian Tafel ◽  
Sharmila Devi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Intervention ◽  
Cord Compression ◽  
Surgical Decompression ◽  
First Year ◽  
Motor Weakness ◽  
The Mean ◽  
The Impact

OBJECTIVEMetastatic spinal cord compression (MSCC) imposes significant impairment on patient quality of life and often requires immediate surgical intervention. In this study the authors sought to estimate the impact of surgical intervention on patient quality of life in the form of mean quality-adjusted life years (QALY) gained and identify factors associated with positive outcomes.METHODSThe authors performed a retrospective chart review and collected data for patients who had neurological symptoms resulting from radiologically and histologically confirmed MSCC and were treated with surgical decompression during the last 12 years.RESULTSA total of 151 patients were included in this study (mean age 60.4 years, 57.6% males). The 5 most common metastatic tumor types were lung, multiple myeloma, renal, breast, and prostate cancer. The majority of patients had radioresistant tumors (82.7%) and had an active primary site at presentation (67.5%). The median time from tumor diagnosis to cord compression was 12 months and the median time from identification of cord compression to death was 4 months. Preoperative presenting symptoms included motor weakness (70.8%), pain (70.1%), sensory disturbances (47.6%), and bowel or bladder disturbance (31.1%). The median estimated blood loss was 500 mL and the average length of hospital stay was 10.3 days. About 18% of patients had postoperative complications and the mean follow-up was 7 months. The mean pre- and postoperative ECOG (Eastern Cooperative Oncology Group) performance status grades were 3.2 and 2.4, respectively. At follow-up, 58.3% of patients had improved status, 31.5% had no improvement, and 10.0% had worsening of functional status. The mean QALY gained per year in the entire cohort was 0.55. The mean QALY gained in the first 6 months was 0.1 and in the first year was 0.4. For patients who lived 1–2, 2–3, 3–4, or 4–5 years, the mean QALY gained were 0.8, 1.4, 1.7, and 2.3, respectively. Preoperative motor weakness, bowel dysfunction, bladder dysfunction, and ASA (American Society of Anesthesiologists) class were identified as independent predictors inversely associated with good outcome.CONCLUSIONSThe mean QALY gained from surgical decompression in the first 6 months and first year equals 1.2 months and 5 months of life in perfect health, respectively. These findings suggest that surgery might also be beneficial to patients with life expectancy < 6 months.

scholarly journals Individualized transscleral cyclophotocoagulation as the initial surgical intervention for medically uncontrolled glaucoma after blunt trauma

2020 ◽  
Author(s):  
Xu Hou ◽  
Jing Wu ◽  
Jian Zhou ◽  
Yu-Sheng Wang ◽  
Dan Hu
Keyword(s):  
Anterior Chamber ◽  
Success Rate ◽  
Blunt Trauma ◽  
Surgical Intervention ◽  
Ultrasound Biomicroscopy ◽  
Anterior Chamber Angle ◽  
Significant Difference ◽  
Transscleral Cyclophotocoagulation ◽  
The Mean ◽  
Chamber Angle

Abstract Background: To investigate the safety and feasibility of individualized transscleral cyclophotocoagulation (TSCPC) as the initial non-incisional surgical intervention for medically uncontrolled glaucoma after blunt trauma. Methods: The therapy records were reviewed of medically uncontrolled traumatic glaucoma after blunt trauma treated with TSCPC in a single hospital between January 2014 and December 2018. 31 patients (31 eyes) received individualized TSCPC after ultrasound biomicroscopy and gonioscopy examination to localize and quantify the injured quadrants of the anterior chamber angle. In addition to the number of IOP lowing drugs, visual acuity (VA), IOP, inflammation and hemorrhage in the anterior chamber were analyzed at 1 day, 3 weeks and 3 months after operation, respectively. Success was defined as the IOP was not more than 21 mmHg.Results: Compared with the data of pre-operation, constituent ratio of VA had no significant difference at 3 weeks (c2 = 0.56, P > 0.75). At 3 months the mean IOP was 22.2±5.0 mmHg, which was significantly lower than that of pre-operation (46.6±5.6 mmHg) (t=19.818, P<0.001). No IOP lowing drug was needed in 12 eyes, and more than 3 kinds of drugs were still needed in 5 eyes. The average number of medications decreased significantly (c2=93.496，P＜0.001). The complete success rate was 38.7% and the relative success rate (combined with no more than two kinds of drugs) was 83.9% at 3 months.Conclusions: Individualized TSCPC could be applied as an initial non-incisional surgical intervention to treat traumatic glaucoma refractory to the medicine therapy.

scholarly journals Determination of Relative Frequency of Calretinin Expression in Patients with Breast Cancer in Yazd, Iran

2020 ◽  
Vol 3 (2) ◽  
pp. 37-40
Author(s):  
Ehsan Arjmandzadeh ◽  
◽  
Fariba Binesh ◽  
◽  
Keyword(s):  
Breast Cancer ◽  
Survival Rate ◽  
Breast Carcinoma ◽  
Tumor Size ◽  
Relative Frequency ◽  
P Value ◽  
Significant Difference ◽  
The Mean ◽  
Positive Results ◽  
Ihc Markers

Introduction: Breast cancer is known as the most common type of cancer among women in the world. Several methods have been proposed to predict the behavior of breast carcinoma. Recently calretinin has been found to be a reliable factor in predicting tumor survival rate in breast cancer. The aim of this study was to evaluate the relative frequency of calretinin expression in patients with breast cancer in Yazd,Iran. Material and methods: In this cross-sectional retrospective study, the clinicopathologic features and the outcome of patients with breast cancer from 2017 to 2018 were reviewed at Shahid Sadoughi Hospital, Yazd, Iran. The influence of potential prognostic parameters in the overall survival was investigated by log-rank test and Cox regression analysis. Results: Among 100 cases with breast carcinoma, 14.5% were positive for calretinin. The distribution of the rate of positivity of IHC markers including ER, PR, P53, Ki67 and Her2 was 62.9%, 57.1%, 46.2%, 80.5% and 22.1%, respectively. The most common grade and stage were grade2 and stage3 respectively. There was no significant difference in the status of IHC markers (including ER, PR, Her2 and Ki67) in terms of calretinin. 66.7% of the patients with calretinin positive results were P53 positive. The results of the mean tumor size distribution in the two groups of positive and negative calretinin showed a significant difference (P-value = 0.05). A lower age at the time of diagnosis was found in patients with calretinin positive results (P-value = 0.119). The mean survival rate in calretinin positive group was 6.71 years and 6.62 years in calretinin negative patients which was not statistically significant. Conclusion: The results of this study indicated an association between calretinin expression and other IHC markers (although not statistically significant) in predicting poor prognosis in breast cancer patients. In addition, we found a statistically significant association among calretinin with smaller tumor size and lower age at the time of diagnosis in patients with breast cancer.

scholarly journals Psychological and social Harmony Among adults: A study field in adolescents care house in Sulaymaniyah

2018 ◽  
Vol 224 (3) ◽  
pp. 317-344
Author(s):  
Assist. Inst. Qoestan Ali Abdullah
Keyword(s):  
Extended Family ◽  
Personality Development ◽  
Special Program ◽  
Absolute Value ◽  
The Past ◽  
Significant Difference ◽  
The Family ◽  
Study Population ◽  
The Mean ◽  
Educational Aspect

    It is worth mentioning that the disintegration of Iraqi family due to poverty and losses of lives due to wars, violence and persecution Iraq has undergone led to several cases of child deprived of one of the parents or both that led many families to put their children in adolescents care houses or orphanage, a responsibility that used to be taken care by relatives in the past. The study population comprises 23 orphan adolescents (8 females and 15 males) who live in an adolescents care house in Sulaymaniyah. The main results as shown in table 12 is that there are a significant difference at 0.01 level in total scores of adjustment among groups where the F value was 5.48 to differentiate significance among means then calculate the absolute value of difference among means which showed the following: a) the are significant differences at 0.05 level between mean scores of adolescents group in care house and those of adolescents in educational aspect.    B) Between mean scores of adolescents there are significant difference between adolescents who receive no care and the mean scores of adolescents who receive no care. c) There are significant differences between mean scores of adolescents who receive no care and the mean scores of adolescence who receive care at care house which are in favor of adolescents who receive no care compared to those who are under care house institution. The differences among care house group mean scores were not significant. d) It is obvious that there are differences in the self-concept among adolescents under different care types, in favor of orphans who live under the care of extended family and receive a special program compared to adolescents under care house. e) The study showed that a child needs siblings who develop with him and share family life, each member of the family has his own role in participating in his personality development and growth and un preparing him for integration and interaction with society.

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