Table of content

Al-Kindy College Medical Journal

مجلة كلية الطب الكندي

ISSN: 18109543
Publisher: Baghdad University
Faculty: Al-Kindy Medicine
Language: English

This journal is Open Access

About

Al-Kindy College Medical Journal ((Al-Kindy Col.Med.J)), a periodic peer reviewed scientific journal published biannually by Al-Kindy College of Medicine –University of Baghdad. specialised
in research of medical and related subject ISNN 1810-9543
The articles and research studies published in the journal are carefully selected and reviewed by a high standard advisory board from doctors who are most seniors and experts in their medical fields according to the subjects submitted to the journal.
Al-Kindy Col.Med.J is well recognized by Baghdad ,Mustansiriya and Nahrain universities for promotion of their teaching staff.
Three hundred articles ,research papers, case reports and studies have been published ourn medical journal since 2003 till now and the journal has been distributed to all medical collages of Iraq and most counties in the Middle East.

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Mobile: +964 7803546157
web site: www.kmc.edu.iq
E-mail: journal@kmc.uobaghdad.edu.iq
info@kmc.uobaghdad.edu.iq

Table of content: 2011 volume:7 issue:2

Article
Human chorionic gonadotropin and Testosterone in Normal and Preeclamptic Pregnancies in Relation to Fetal sex

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Back ground: The gender related difference may be the result of pregandiol excretion in the latter half of pregnancy. Aim: This study is to evaluate the effects of fetal gender on serum human chorionic gonadotropin [HCG] and testosterone in normotensive and preeclamptic pregnancies Methods: The study consisted of fifty women with singleton pergnancy in their third trimester. Twenty five pregnancies were uncomplicated Among those there were thirteen male, and twelve female fetuses Twenty five pregnancies were complicated by preeclampsia. Among those thirteen were with male, and twelve were with female fetuses. Human chorionic gonadotropin and total testosterone were measured in maternal peripheral blood. Results: In male bearing pregnancies, maternal HCG and testosterone serum levels were significantly higher in preeclamptic than in normotensive mothers. In female bearing pregnancies, testosterone levels were significantly higher in preeclamptic than normotensive mothers, whereas the HCG levels were not significantly different.Male Bearing preeclamptic women had significantly higher testosterone levels than female Bearing preeclamptic women, whereas the HCG levels were not significantly different. In uncomplucated pregnancies the HCG levels significantly higher in female bearing than in male bearing mothers, Conclusion: In preeclamptic pregnancies with male fetuses; the maternal serum HCG levels were significantly higher than in uncomplicated pregnancies. Total testosterone level were significantly higher in pregnancies whether with male or female fetuses. It was also significantly higher in male bearing than female bearing pregnancies. This may indicate an androgen influence on the pathophysiologic of preeclampsia


Article
Helicobacter Pylori Seropositivity and Acute Myocardial Infarction

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Background: Acute myocardial infarction (AMI) is one of the most common diagnoses in hospitalized patients. The stimulus that initiates the acute inflammatory process in AMI has not been identified. Conventional risk factors account only for approximately half of the patients with clinically apparent atherosclerosis which can leads to AMI. Recently a potential link between infectious agents and atherosclerosis has been suggested Objective: To find a possible association between Helicobacter pylori (H. Pylori) infection and AMI. Method: We studied the prevalence of anti-H. pylori antibodies in 94 patients who were admitted with the diagnosis of AMI and a similar number of healthy individuals who were age and sex matched. This was done using ELISA technique. Results: Overall prevalence of anti-H. pyroli antibodies in patients with AMI was 82.9% whereas the prevalence in the control group was 78.7% . This difference yielded an odd ratio of 1.317. Chi square test shows that this difference was insignificant statistically (p-value 0.458) Conclusion: We feel that our results do not support the hypothesis which stated that chronic infection with H. pylori is a major risk factor for AMI.


Article
T-Cells Proliferation and Serum Cytokine levels in Type 1 Diabetic Children

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Background: There is plenty of evidence suggesting that involvement of several groups of viruses in the development and / or acceleration of Type 1 Diabetes Mellitus (T1DM). Objective: To analyze the T- cell proliferation in the presence of Coxsackie virus B5 (CVB5), Polio and Adenovirus antigens in addition to assessment of Interferon- gamma (IFN-γ), Interleukins (IL-10 and IL-6). Methods: In 60 Iraqi T1DM children with recent onset of T1DM, Lymphocyte proliferation was analyzed using Methylthiazol tetrazolium (MTT) assay by culturing Peripheral Blood Lymphocytes (PBLs) with Coxsackie Virus B5 (CVB5), Adenovirus, and Polio vaccine. Serum Interferon-γ, IL-10 and IL-6 were quantified by sandwich ELISA. Results: No significant differences were shown in the PBL proliferative percentage in response to Con-A mitogen and tested viruses (CVB5 and Adenovirus) between T1DM and healthy controls, but it showed a significant decline in patients in response to Polio vaccine. Higher significant serum levels of IFN-γ, IL-10, and Il-6 were observed in the investigated patients compared to controls (p<0.05). Mean PBL proliferative percentage in response to tested viral antigens was correlated with the serum IFN-γ, IL-6 and IL-10 levels. Conclusions: In children with new- onset diabetes, mean proliferative percentage of Peripheral Blood Lymphocytes was generally decreased. A significant elevation of serum levels of IFN-γ, IL-10 and IL-6 were observed, which is significantly correlated to mean proliferative responses of PBL to viral antigens.


Article
Postprandial Hyperglycemia as a Significant Risk Factor for Coronary Heart Disease

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Background: The highest concentrations of blood glucose during the day are usually found postprandialy. Postprandial hyperglycemia (PPH) is likely to promote or aggravate fasting hyperglycemia. Evidence in recent years suggests that PPH may play an important role in functional & structural disturbances in different body organs particularly the cardiovascular system. Objective: To evaluate the effect of (PPH) as a risk factor for coronary Heart disease in Type 2 diabetic patients. Methods: Sixty-three type2 diabetic patients were included in this study. All have controlled fasting blood glucose, with HbA1c correlation. They were all followed for five months period (from May to October 2008). A two hour postprandial glucose (PPG) was done for all. Other risk factors were taken in consideration such as hypertension, obesity, and dyslipidemia. The study was performed on those patients after at least three months of controlled fasting blood glucose. ECG was done to all of them. Results : Out of the 63 type 2 diabetic patients, 20 had normal PPG and HbA1c levels, one of them (5%), has ischemic changes on ECG twenty patients had normal HbA1c & High PPG with 7 (35%) of them showed ischemic changes on ECG 17 patients showed a high PPG and a high HbA1c with four of them showed ischemic changes on ECG P<0.05. The remaining 6 patients had normal PPG but high HbA1c & also only one of them showed ischemic changes on ECG. Conclusion This study showed that PPH is a significant risk factor for ischemic heart disease (IHD).


Article
Inhibitory Effects of Aqueous Extract of Garlic on Growth and Keratinase Activity of Trichophyton Mentagrophytes

Authors: Israa M. Abd AL-Khaliq
Pages: 33-36
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Background: The effect of garlic extracton fungal growth and keratinolytic activity was studied in Trichophytonmentagrophytes as one of the major etiologic agents of human and animal dermatophytosis in Baghdad and other parts of the World. Objective: To investigated an alternative antidermatophyte with minimum side effects which is plant based and biodegradable natural product Methods: Culture conditions for 30 isolates of T. mentagrophytes isolated from human dermatophytosis from both sexes with ages of 5-63 years in Central Medical city for the period July 2009 to October 2009 were cultured on specific solid medium. Results: The aqueous extract of garlic at various concentrations inhibited the growth of T. mentagrophytes. This inhibition reached to a maximum of 100٪ for extract at 10٪concentration. Keratinase synthesis was also inhibited by the extract about 91 ٪at 8 ٪ concentration. Conclusion: Fungal growth and keratinolytic activity are important factors in pathogenesis of the dermatophytes, their inhibition by garlic indicate that this substance may have potential values for treatment of human and animal dermatophytosis.


Article
None anticipated bacterial urinary tract infections in type 2 diabetic patients relative to duration and angiopathies

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Background: Diabetes mellitus is a well known metabolic and vascular illness associated with high incidence of bacterial urinary tract infections especially in diabetic complications including both micro and macro-vascular types. Objective: To study the incidence of bacterial urinary tract infections in type 2 diabetic patients, the type of micro-organism responsible in relation to age, sex of patients, duration of the disease & related micro & macrovascular diabetic complications. Methods: A prospective study of the diabetic patients including 40 males with mean age of 54(±9) years and 50 females, mean age of 51(±7) years and duration of the and sex matched controls (27 males and 33 females). Symptoms of urinary tract infections, general urine examination, urine culture & ultrasound of abdomen were studied & reported for both groups. Results: This study showed significant increase in urinary tract infections among diabetic patients with four fold rise in bacteriuria especially among diabetic women & Escherechia Coli was the predominant micro-organism in 85% of cases. Conclusion: Urinary tract infection has significant increase incidence in type 2 diabetic patients with fourfold rise among diabetic women.


Article
Etiologies of chronic cough in adult patients: Is it hard to be diagnosed?

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Background: Chronic cough is often the key symptom not only of chronic pulmonary diseases but for other important extrapulmonary pathologies, in particular upper airway and gastrointestinal diseases. Objective: This study was designed to determine the etiology of chronic cough and the usefulness of the available diagnostic tests in reaching its causes. Methods: One hundred patients presenting with chronic cough at Baghdad Teaching Hospital Outpatient Clinic were enrolled in this study. The patients underwent a full clinical interview, physical examination with indicated diagnostic test(s) (such as chest x ray, bronchoscope, PFT, GIT study, sinus X ray or CT). Results: An etiology of chronic cough was determined in 93% of the patients. Post nasal drip is the leading cause of chronic cough reported in 31% of the patient, while asthma gastro-esophageal reflux disease, and chronic bronchitis seen in (26, 20, and 6 % respectively). The diagnosis of chronic cough can be reached by comprehensive history, proper physical examination, and chest X ray findings in 66 % patients, further more sophisticated and invasive tests like: PFT, upper GIT study , expectorated sputum examination (AFB, Gram staining, cytology), fibrooptic bronchoscope, and full ENT evaluation including sinuses X ray or sinuses CT scanning, are need in the rest. Conclusion: The etiology of chronic cough can often be diagnosed safely with a simple initial evaluation (history, physical examination and chest X-ray). Postnasal drip, asthma and gastroesophageal reflux disease account for the etiology in more than three quarter of the patients.


Article
The Role of Some Medicinal Plants in the Management of Peptic Ulcer

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Background: Plants used in folk medicine for the treatment of peptic ulcer diseases is a very promising approach to overcome the limitations of classical medicines. Aim: To explore the efficacy of medicinal plants, namely turmeric, garlic and marshmallow, in eradication of H. pylori. Methods: This prospective study was carried out on 225 of well-known dyspeptic patients who were divided into four groups; a control group (received classical medical therapy) and three other groups that received one of the three medicinal plants, plus the same therapy used in the control group. The follow up was done by using a questionnaire form, endoscopic examination, and determination of serum levels of anti H.pylori antibodies & gastrin by using ELISA test. In addition, liver enzymes were monitored by using spectro-photometer to prove the safety of medicinal plants. Results: The rate of recurrence of peptic ulcer disease was decreased in patients who received the combined therapy when compared to the patients in control group. Medicinal plants were effective in decreasing the recurrence of H. pylori infection when each one of them was used in combination with the medical therapy without causing harmful effects on the liver. Conclusion: Turmeric, garlic & marshmallow are effective in management of peptic ulcer with low cost.


Article
Causative Organisms and Risk Factors In Bacterial Meningitis in Al-Elwia Childhood Hospital - Baghdad

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Background: Childhood meningitis is a major cause of morbidity and mortality, Hemophilus influenza b (Hib) is the most common cause in many countries, especially below 5 years and before the development of conjugated Hib vaccine, it is followed by Streptococcus Pneumonia, and then N. meningitides, in addition to other microorganisms. Objective: To identify the causative organisms of bacterial meningitis and to identify the factors predisposing significantly to the incidence of bacterial meningitis. Method: This cross sectional , study was done in Al-Elwia Pediatric Hospital during the period 1st of January 2007 to 30th of June 2007.Eighty four patients with presumptive diagnosis of meningitis were included in this study, from the age of 2 months -12 years, History about some risk factors were taken in details. Analysis of cerebrospinal Fluid (CSF) with Gram stains & cultures were done in all cases. Results: The number of cases of meningitis was 50 (20 proved meningitis & 30 partially treated meningitis), while 34 patients are found to have no meningitis. Streptococcus pneumoniae was identified in 45%, Hemophilus Influenza b in 20%, while Nisseria meningitides 5%, other organisms include Escherichia coli, Staphylococcus aureus, Klebsiella, & salmonella. Many factors affecting the occurrence of bacterial meningitis & these include: age, sex, residence, body weight and home overcrowding. Conclusions: Streptococcus pneumoniae was found to be the predominant microorganism causing bacterial meningitis in children aged 2 months-12 years, followed by Hemophilus influenza b, while N. meningitides were one of the rare bacteria which had been identified. E. coli was found to be the major cause in cases of ventriculo-peritoneal (VP) shunt meningitis.


Article
Excessive crying in infancy; value of the history and physical examination

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Background: Excessive crying in early infancy is a common condition that causes a great deal of concern to the parents and physician. Objective: The aim of this study is to find the underlying etiology of excessive crying in infancy and to determine how the history, physical examination, and laboratory investigations contribute to the final diagnosis. Method: A prospective study done on 150 afebrile infants less than 4 months of age visited Al-Elwia hospital for children complaining of excessive crying of more than two hours. The study done over a one year period from the first of January 2009 to the end of December 2009. All febrile infants and those with acute illness preceding the onset of crying were excluded from the study. Results: Of 150 afebrile infants with excessive crying 95 cases (63.3%) diagnosed as having idiopathic colic, 55 cases (36.7%) have a secondary underlying disorder. The most common associated disorders include constipation, 12 cases (8%), gastro-esophageal reflux in 9 cases (6%), and feeding problems in 9 cases (6%). Urinary tract infection was the most common underlying serious etiology found in 4 cases (2.7%). History and physical examination contribute to the final diagnosis in 85% of cases. Conclusion: Accurate diagnosis of infants with colic or excessive crying requires a thorough history and physical examination to exclude underlying etiology. Screening laboratory tests apart from urine analysis and culture is of little help.

Keywords

infant --- colic --- excessive crying.


Article
Increase serum leptin level in Helicobacter pylori infection in Iraqi gastritis patients

Authors: Sana’a Khudhur سناء خضر
Pages: 74-77
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Background: H.pylori colonized gastric mucosal epithelium will virtually develop gastritis and had the capacity to persist for decades. Pathogenesis is dependent upon strain, virulence host genetic susceptibility, and environmental cofactors. Leptin is a member of the class 1 cytokine family so altered leptin production during ifnect and inflammation that leptin part of the cytokine cascade ,which orchestrates the defense mechanism. Objective: Examin the effect of H.pylori infection on serum leptin level. Methods: One hundred and thirty(130) Patients attending the Endoscopic Unit at "Gastroenterology and Hepatology Teaching Hospital/ Baghdad Medical City"were included in this study with ages range from 18 years to 65 years are the source of specimens to undergo oesophageal gastroduodenoscopy (OGD) compared with twenty healthy control the study began from April 2009 to the end of March 2010 were eligible for this study.Tow types of samples were taken, biopsy for rapid urease test and histopathological examination to detect H.pylori and blood sample for estimation of serum leptin by ELISA test. Results: The results show significant increase in serum leptin concentration(P<0.001)in gastritis patients caused by H.pylori compared with patients control and healthy control. Conclusion: Increase of serum leptin concentration explained the role of leptin in the immune response to H.pylori infection that leptin consider as member of cytokine.

Keywords

Leptin --- H.pylori --- gastritis


Article
Laparoscopic versus open appendectomy in patients with acuteappendicitis

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Background: Laparoscopic surgery for appendicitis is now a well established and advanced method of performing general surgical procedures. Objectives: To compare the outcome of laparoscopic and open appendectomies in terms of operative time, analgesic requirement, postoperative complications, hospital stay, return to normal activity and condition of scar. Methods: This prospective study was carried out from 1stMay 2008-1st January 2010, involving 110 patients (45 male and 65 female) with features suggestive of acute appendicitis were divided into 45 patients laparoscopic appendectomy (LA) group and 65 patients open appendectomy (OA) group, after taking informed consent. LA was done with the help of three trocars/cannulae creating pneumoperitoneum with CO2 whereas OA was performed by grid iron incision. Results: Forty five patients were assigned to the laparoscopic appendectomy group and 65 patients were assigned to the open appendectomy group. Five patients were converted intra-operatively from laparoscopic appendectomies to open procedures. The operating times in OA and LA were 20-110 minutes (mean 30) and 45-120 minutes (mean 55) respectively. Increased doses of analgesics, antibiotics and antiemetics were required in OA, as compared to LA. The mean postoperative hospital stay in LA group was 1 day (range 1-3 days) where as it was; 2.2 days (range 2-5 days) in OA group. Conclusion: LA is safe and it has major benefits like less postoperative pain, decreased wound infection, early hospital discharge, early return to work and a better cosmetic scar than OA.


Article
Comparison Between Mechanical and Non Mechanical Bowel Preparation Prior To Elective Colorectal Surgery

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Background: Bowel preparation prior to colonic surgery usually includes antibiotic therapy together with mechanical bowel preparation which may cause discomfort to the patients, prolonged hospitalization and water & electrolyte imbalance. Objective: to assess whether elective colon and rectal surgery may be safely performed without preoperative mechanical bowel preparation. Method: the study includes all patients who had elective large bowel resection at Medical City – Baghdad Teaching Hospital between Feb, 2007 to Jan, 2010. Emergency operations were not included. The patients were randomly assigned to the 2 study groups (with or without mechanical bowel preparation. Results: A total of 165 patients participated in the study, 82 with mechanical bowel preparation and 83 without. The 2 groups were similar in age, sex and type of surgical procedure. 134 patients (81.2 %) underwent surgery owing to colorectal cancer & 31 patients (18.8 %) owing to benign disease. The hospitalization period was longer in the bowel-prepared group (mean ± SD, 8.2 ± 5.1 days) as compared with the non prepared group (mean ± SD, 8.0 ± 2.7 days). However, this difference was not statistically significant. The time until the 1st bowel movement was similar between the 2 groups : a mean ± SD of 4.2 ± 1.3 days in the non prepared group as compared with a men ± SD 4.3 ± 1.1 days in the prepared group ( P = NS ). Conclusion: Our results suggest that no advantage is gained by preoperative mechanical bowel preparation in elective colorectal surgery.


Article
Antinociceptive Effect of Silymarin in Experimental Animal

Authors: Ahmed S. Sahib احمد صهيب
Pages: 91-94
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Background: Silymarin is a polyphenolic flavonoid derived from milk thistle (Silybum marianum) that has anti-inflammatory, cytoprotective, anticarcinogenic and antioxidant effects. It has been used medicinally to treat liver disorders including acute and chronic viral hepatitis, toxin/drug induced hepatitis, and alcoholic liver disease. Objective: To evaluate the antinociceptive effect of silymarin in experimental animal model of pain. Methods: The efficacy and dose response effect of silymarin (125, 250, and 500mg/kg) were assessed against control using tail flick test in mice as a model of nociceptive pain. In this model, all doses of silymarin were given intraperitoneally 15 min before immersion of tail in hot water 50°C, and Tail Flick Latency was measured before, and after (15, 30, 60 and 120 min) administration of silymarin. Result: Silymarin in 250 and 500mg/kg significantly increase Tail Flick Latency after 15, 30, 60 and 120 min in a dose dependent manner that the maximum effect seen after 120 min compared to baseline value. Conclusion: Silymarin as a herbal drug produce a significant antinociceptive effect in experimental animal model of pain, and beside its better standardization, quality control, and safety profile, in addition to its availability and relative low cost, represent a good alternative choice for management of pain.

Keywords

Silymarin --- milk thistle --- pain


Article
Outcome of surgical treatment of high-grade intramedullary astrocytomas

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Background: Intramedullary astrocytomas account for about 1% of all CNS tumors and 6–8% of spinal cord tumors. The vast majority of intramedullary astrocytomas are slow-growing lesions. Objectives: The goal in this study was to review a series of patients who underwent surgical removal of intramedullary high-grade astrocytomas, focusing on the functional outcome and the effect of multimodality treatment on the survival of patients with high grade intramedullary astrocytoma. Methods: Between June 1999 and June 2004, 22 patients underwent removal of intramedullary high-grade astrocytomas in four neurosurgical hospital in Baghdad/ Iraq (Neurosurgical hospital, Al Shaheed Adnan Hospital for Surgical Speeialticsa, Nursing Home Hospital Lesions were located in the cervical segment of the spinal cord in 12 patients, and patients. Results: Histological examinations showed 10 Grade III astrocytomas and 12 glioblastomas. Only 2 of the 22 high-grade astrocytomas could be completely removed. The clinical postoperative status worsened in 14 patients (63.6%), was unchanged in seven patients (31.8%), and there was one case of intraoperative death (4.5%). None of the 22 patients showed improvement in their neurological status postoperatively. In this series, excluding the one intra-opera¬tive death, all patients died of the progression of the malignancy. Conclusions: Surgical treatment did not ameliorate the postoperative neurological status; instead, in the majority of cases, it prompted a worsening of the deficit. Radiotherapy and chemotherapy have a little influence on the length of survival. In this series, multimodality treatment of intramedullary high-grade astrocytomas has been shown to increase length of survival without improving the neurological status.


Article
Intraoperative Steroid Irrigation in Carpal Tunnel

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Background: Carpal tunnel syndrome (CTS) is the most common neuropathy of the upper limb due to compression of the median nerve at the wrist. Objectives: to test the benefit of steroid irrigation of the wound to alleviate the post operative pain. Methods: Forty patients had carpal tunnel release were divided into two groups with and without steroid irrigation. Results: Forty patients 38 female and 2 male with forty CTS had open surgical release were studied for postoperative pain at the wrist area. Group 1 (patients treated with surgery alone) and group 2 (patients treated with surgery and steroid).In group1, 11 patients (55%) had persistent agonizing pain at the ulnar side of the wrist not responding to analgesic. In group2 none of the patients experienced such type of pain. Conclusion: Steroid irrigation has beneficial effect on post operative pain with no added drawbacks.


Article
The Incidence Of Recurrent Laryngeal Nerve Injury During Thyroid Surgery

Authors: Laith Hindosh ليث هندوش
Pages: 111-118
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Background: Recurrent laryngeal nerve injury is an important post-thyroidectomy complication for which different modalities of treatment were practiced to lower its incidence. Objectives: To estimate the incidence of recurrent laryngeal nerve injury in thyroid surgeries in relation to type of surgery, type of gland diseases & nerve identification. Methods: Different types of goiters prepared preoperatively by indirect laryngoscopy, operated upon with different types of surgeries, postoperative direct laryngoscopy by the anaesthetist were done and indirect laryngoscopy done as needed. Results: Of of 200 patients, the overall incidence of recurrent laryngeal nerve injury was 9 Patients (4.5%), 7 patients (77.8%) were unilateral nerve injury & 2 patients (22.2%) were bilateral nerve injury. The percent of temporary nerve injury was 8 patients (88.89%) & permanent injury 1 patient (11.11%).the incidence of injury in females was (4.57%) & in males was (4%). Injury was 1 patient out of 13 (7.69%) in total thyroidectomy, 1 patient out of 11 (9.09%) in completion thyroidectomy. Injury in malignant goiter was 2 patients (10%).finally it was higher if nerve was not identified (6.15%) than if identified (1.42%). Conclusion: Recurrent laryngeal nerve injury is more in malignant goiters, in more extensive surgery & if peroperative nerve identification was not practiced.


Article
Primaryb realignment of Traumatic posterior urethral rupture.

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Background: Posterior urethral rupture remains one of the most difficult and controversial injuries to treat and its management still controversial. Aim: To assess the effect of primary realignment of posterior urethral rupture. Methods: in this study, 20 patients (mean age 24.7 years, range 12 to 39 years) were admitted to al-kindey teaching hospital, Baghdad, Iraq, with complete posterior urethral rupture associated with fractured pelvis following trauma (3 cases of fall from high, 17 cases of road traffic accidents). All the patients were operated upon at the day of accident to establish the alignment of the posterior urethra on a Foley's catheter with bladder drainage by suprapubic catheter. Patients were evaluated post-operatively for urinary incontinence, erectile dysfunction, and urethral stricture. They were followed up for a mean period of 17 months (range, 10 to 20 months). Results: posterior urethral rupture was associated with pelvic fractures in 18 of 20 patients (90%), and only one case had bladder rupture (5%). Seven patients (35%) had evidence of post operative stricture. Erectile dysfunction was reported by 2 patients (10%). none of the patients had urinary incontinence. Conclusion: Primary realignment of PUR is a simple procedure associated with low morbidity. It is recommended for patients who are stable and have no other significant intra-abdominal and pelvic organ injuries.

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Article
The Role of the Use of Low Molecular

Authors: Auday H. Jasim عدي جاسم
Pages: 123-130
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Background A prospective clinical study was performed to compare the efficacy of the use of low-molecular-weight heparin group (enoxparin group) with control group in the prevention of deep-vein thrombosis after total knee arthroplasty. Aim of the study: to assess the prevalence of DVT after total knee arthroplasty and evaluate the importance of the use of low molecular weight heparin in the prevention of this DVT. Methods Thirty-three patients undergoing total knee arthroplasty were randomly divided into two groups. One group consisted of 12 patients who received no prophylaxis with an anticoagulant (the control group), other group consisted of 21 patients who received the low-molecular-weight heparin enoxparin (enoxparin group) 4000 I.U. S.C 6 hours after surgery for two weeks after the operation then aspirin 100 mg until 6th week after operation. Bilateral duplex ultrasonography was performed preoperatively and at (5-7) days postoperatively. Results The prevalence of deep-vein thrombosis was 58% in the control group, 38% in the enoxparin group. Conclusions Enoxaparin significantly lowered the prevalence of deep-vein thrombosis after total knee arthroplasty.


Article
Early and late Biliary Complications of Laparoscopic Cholecystectomy in Acute Cholecystitis

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Background: Laparoscopic cholecystectomy has become the standard of care for the elective management of cholelithiasis. Little information exists, however, regarding the appropriateness of this procedure in the setting of acute symptomatology. Objective: This study was designed to evaluate the outcome of laparoscopic cholecystectomy in acute and severe acute cholecystitis based on early and late biliary complications, their incidence and management, and conversion rates to open surgery. Methods: A prospective study done between April 2007 and November 2010, in the department of general surgery, medical city teaching hospital, Baghdad. Includes patients with acute cholecystitis admitted for laparoscopic cholecystectomy; they were divided into two groups, (group 1) including patients with acute cholecystitis; (group 2) including patients with severe acute cholecystitis. Results: 306 patients were admitted for laparoscopic cholecystectomy, 71 (23.2%) of them with acute cholecystitis and was involved in this study; they were divided into two groups, (group 1) patients with acute cholecystitis 61(85.9%), (group 2) patients with severe acute cholecystitis 10 (14%); including gangrenous gallbladder 3(30%), and empyematous gallbladder 7(70%). Patients in group 2 were significantly older than in group 1. Female sex was more significant in group 1, while male sex was more significant in group. There was no procedure related mortality. Conclusion: laparoscopic cholecystectomy for acute cholecystitis is safe and associated with a low morbidity, mortality, and a low conversion rate.


Article
Sensorineural Deafness Among Patients with Chronic Renal Failure in Al-kindi Teaching Hospital

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Background: Patients with chronic kidney disease have different grades of sensorineural deafness . Objective: To study the incidence of sensorineural hearing loss and possible contributing factors in patients with chronic kidney disease. Methods: A total of 100 patients with chronic kidney disease were studied. All of them were males. 92 of them were on regular haemodialysis programme. Only 8 patients were on conservative management the age range of the study patients was 18-40 year patients were divided into three groups according to age. All patients were assessed clinically and were evaluated by audiometry , and analysis was made on bone conduction threshold .The mean follow up period was 28 weeks . Results: 36 patients (36 %) showed sensorineural hearing loss .The incidence of sensorineural deafness was found to increase with the advancing age and duration of chronic kidney disease but not directly proportional to the number of haemodialysis sessions .The number of haemodialysis sessions did not show increase in the degree of sensorineural deafness . Conclusion: Patients with chronic kidney disease have sensorineural deafness of some degree which should be assessed and evaluated to halt its progression.


Article
Innervation of the pineal gland in the rat: A chromotolysis study

Authors: Hadi J. Ali هادي جواد علي
Pages: 142-147
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Back ground: The innervations of the pineal gland from the superior cervical ganglion have shown some form of a chromatolysis reaction. Objective: 1-Tracing the innervations of the pineal gland by removing the target tissue (the pineal gland in this study) i.e. (pinealoctomy) and removal of the superior cervical ganglion i.e. (ganglionectomy). 2- The localization and total number of the neurons which project into the rat pineal gland 3-The effect of pinealoctomy on the SCG after a different time interval. Methods: Twenty five albino rats were used in this study, Pinealoctomy was done, then after a different time interval ganglionectomy was done, in order to study the Chromatolysis in their cell body. Result: The present study has demonstrated that the chromatolysis reaction in the neurons following Pinealoctomy confirms the innervations of the pineal gland from the SCG. The present study has demonstrated that the most obvious the Chromatolysis reaction occurred one day after pinealoctomy. Conclusion: This study confirms the innervations of the pineal gland from the SCG, the study shows that the distribution of the Chromatolysis neurons; of all age group occurred in all parts of the ganglion; although it was more abundant in the rostal 2/3.


Article
MODIFIED ALVARADO SCORING SYSTEM.

Authors: Raid E. Rassam رائد رسام
Pages: 148-156
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Background:-The Modified Alvarado Scoring System (MASS) has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. However, differences in diagnostic accuracy have been observed if the scores were applied to various populations and clinical settings. Objectives:- The purpose of this study was to evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis in our setting. Methods:-one hundre twenty eight patients, were included in this study, admitted to Al-Kindy teaching hospital from June 2009 to June 2010. Patients’ age ranged from 8 to 56 years (21±10) they were divided into three groups; paediatrics, child bearing age females & adult males,. MASS was calculated for each patient included as the diagnosis & treatment were done on the bases of surgeon's clinical decision,confirmation was done by histopathological examination. Finally statistics done included negative appendectomy rate, sensitivity, specificity, positive predictive value,negative predictive value & accuracy. Results: - Our negative appendectomy rate was 19.5% (22.22% for paediatrics 40.9% for females 4.2% for males). MASS showed sensitivity of 61%(92.8% for paediatrics 38% for females & 58% for males), specificity 80% (75% for paediatrics 88% for females & 50% for males), positive predictive value 92%(92.8% for paediatrics 83% for females 50% for males), negative predictive value 33% (75%for paediatrics 50% for females 5% for males) & accuracy 65% (88.9% for paediatrics 59% for females 58% for males). Conclusion:- MASS was of limited help to junior doctors in our setting,clinical assessment & experience are still the gold standard for acute appendicitis.

Table of content: volume:7 issue:2