Table of content

Journal of the Faculty of Medicine

مجلة كلية الطب

ISSN: 00419419 / 24108057
Publisher: Baghdad University
Faculty: Medicine
Language: English

This journal is Open Access


Journal of the Faculty of Medicine – University of Baghdad

A peer- reviewed journal published Quarterly by the college of medicine –Baghdad University

ISSN: 0041-9419

E-ISSN 2410-8057

The Journal interested in publication of clinical and basic medical research.

The first issue of this Journal was published under the name of (Journal of the Royal Iraqi Medical College) in April /1936, approved by the council of the College as a general journal dealing with the news of the college and few scientific articles to encourage the teaching staff for research publication. The journal was published randomly and ceased during World War II due to financial difficulties.
In 1946 Prof. Dr. Hashim Al Witri, the college dean, assigned republication of the journal and urged the teaching staff to participate and publish their research in the journal. Despite his effort the journal remained irregular in publication. In 1959 Prof. Dr. Faisal Al-Sabih became the Editor in Chief of the journal when he returned from the United Kingdom and appointed on the teaching staff, restructured the journal and changed its name to (The Journal of the Faculty of Medicine) and used new scientific system for publication of articles.
The first issue of the new series started in June 1959. The journal continued to be published on a regular basis since then without interruption in (four issues during the year). The journal became registered the international number (ISSN) in 2000 and entered in many important international indexes.
After 2003 the journal continued despite the difficulties involved in every aspect of the country and by the beginning of 2004 the journal progressed through a series of changes to reach a level that can be recognized internationally.
After 2010 the journal became published electronically of the same edited issues.
Recently the journal became recognized by the (Index Copernicus) and publicised internationaly.

Contact info

Table of content: 2008 volume:50 issue:3

Prevalence of autoimmune hemolytic anemia in ulcerative colitis

Authors: Khalid A. Al-Khazraji
Pages: 273-281

Background: Ulcerative colitis is a chronic idiopathic inflammatory disorder that affects the
rectum & extends proximally to affect variable extent of the colon. Autoimmune hemolytic
anemia had reported in few cases.
Objective: to determine the prevalence of autoimmune hemolytic anemia in Ulcerative
Patient & Methods: Fifty Iraqi patients having Ulcerative colitis attending the GIT Center in
Baghdad during the period from March to August 2004 were interviewed, examined and
diagnosed according to pathological study done for colonic biopsies by the same centre.
Blood was drown for the assessment of complete picture with blood film, reticulocyte
percent, erythrocyte sedimentation rate, Coombs test (direct, indirect), antinuclear antibody,
immunoglobulin assay, serum iron and TIBC in the same laboratory unit.
Results: In our study, 18(36%) patients were anemic, fifteen of them had normal or low
reticulocyte percent with normochromic normocytic RBC in blood film, probable causes of
anemia was either iron deficiency proved by low serum iron and high total iron binding
capacity (TIBC), or anemia of chronic illness. The remaining three of eighteen patients with
reticulocytosis, two of them Coombs test were negative and normal film, but they were
having acute bloody diarrhea which probably was the cause of reticulocytosis.
The third patient was Coombs positive with features of hemolytic anemia in the blood film
(polychromic with spherocytosis), this patient had also a high titer of IGg, LDH, so that this
female had all the evidence of autoimmune hemolytic anemia which is a rare complication of
Ulcerative colitis.
Salfasalazine as a treatment of Ulcerative colitis can cause autoimmune haemolysis, but in
this case the drug had stopped for one month before the development of autoimmune
In our sample we had five patients with reticuloytosis but normal haemoglobin level and
normal blood film with cooms negative (direct and indirect) those five patients might had
nonimmune causes of hemolytic like G6PD deficiency which need further investigations, or
might had bloody diarrhea which cause elevated reticulocyte as areaction to blood loss, or it
may be due to salazopyrine effect which may lead to increase level of reticulocyte.
Conclusion:Most studies giving range of autoimmune haemolytic anaemia with Ulcerative
colitis between 1%-2%, all these studies showed direct coomb's test positive, and our study
showed 2% incidence. So it is one of the rare manifestations of Ulcerative colitis. It does not
depend much on severity, duration and degree of colonic involvement.

Coronary angiographic findings in patients with chest pain and rightbundle branch block


Back ground : Coronary artery diseases are not uncommon in the presence of right bundle
branch block .
Aim : The aim of this study is to assess the findings of coronary angiography in patients with
chest pain and right bundle branch block.
Methods : The study involved review of case sheets and coronary angiography of one
hundred patients, who underwent coronary angiography due to chest pain suspected to have
coronary artery diseases (CAD) , fifty patients of them had right bundle branch block (RBBB) ,
the other fifty did not have RBBB , those 100 patients were presented to Ibin Al Bitar hospital
for cardiac surgery from January 2004 to June 2006.
History, clinical examinations, electrocardiogram (ECG) , ECG exercise tests (EET)
echocardiogram (ECHO) and coronary angiography had been performed.
Results : Mean age of patients was 53± 10.6 years, 84% were male , hypertension, diabetes
mellitus, and smoking as risk factors were present as 30%, 32% and 48% respectively. 58% of
patients presented with chronic stable angina (CSA) while 42% with acute coronary syndrome
(ACS), ECHO showed that left ventricular dysfunction (LVD) was present in 34%, EET was
positive in 11 of the 23 patients (47.8%) who were able to perform EET. Normal coronary
angiography found in 20% of patients and there were no significant difference in coronary
angiographic findings between patients with and without RBBB.
Conclusion : RBBB of indeterminate age has no significant impact on clinical and
haemodynamic characteristics of CAD patients and it may be incidental finding.

Survival of Patients with CML on Imatinib Experience with 44 IraqiPatients

Authors: Nabeel Salman --- Batool A.G. Yassin --- Ali M.Jawad
Pages: 286-295

Background: Chronic myeloid leukemia (CML) is a clonal stem disease with distinctive
clinical course which is ultimately fatal. It is characterized by the presence of Philadelphia
chromosome (t 9:22).Tyrosine kinase inhibitors like imatinib mesylate as targeted therapy had
revolutionized the management of CML with significant prolongation of overall survival and
decreased rate of blastic transformation.
Objective:This study will describe the experience of treating 44 Iraqi patients with chronic
myeloid leukemia by imatinib at the National Hematology Centre in Baghdad.
Patients and Methods:This study included 44 Iraqi patients diagnosed in Chronic phase CML
at the National Centre of Hematology in Baghdad from February 2003 till January 2006, all
were pretreated with alfa interferon and hydroxyurea. All patients were started on imatinib
mesylate 400 mg orally daily. The end points included overall survival (OS) and Blastic
transformation free survival (TFS).The effect of age, gender, WBC count on starting Imatinib,
presence of splenomegaly and duration of diagnosis of CML prior to starting imatinib, on the
OS and TFS were studied.
Results:Median age was 35 years with 27 males and 17 females. The 3 year OS was 88.6%
and the TFS was 79.5%.The only factor that had negative impact on OS and TFS was a
diagnosis of CML more than 2 years before starting imatinib. The most common side effects
were myalgia(75%) and peripheral oedema(65%). Neutropenia(20%),thrombocytopenia(12%)
and elevated serum transaminases (2%) necessitated temporary cessation of treatment.No
cytogenetic and molecular studies were available .
Conclusion:Imatinib is an effective therapy for Iraqi patients with CML with tolerable side
effects and should be offered to newly dignosed CML patients as early as possible as frontline
therapy to ensure better OS and TFS.Establishment of cytogenetic and molecular studies are
crucial to optimize management.



Background: Langerhans cell histiocytosis (LCH) is a rare proliferative disorder of histiocytes
encompasses a wide clinical spectrum, ranging from a benign localized disease to acute
generalized disease with fatal outcome.
Objectives: to retrospectively evaluate clinical characteristics at diagnosis and outcome of
patients with Langerhans cell histiocytosis.
Patients and methods: A retrospective analysis of data on 21 children with Langerhans cell
histiocytosis followed at Oncology unit, Children Welfare Teaching Hospital, Medical City,
Baghdad, between 1999 and 2006.
Results : The age at time of diagnosis of LCH ranged from 3 months to 9 years, with a median of
22 months, and male to female ratio was 1:1.1. The duration of the onset of the disease before
diagnosis ranged from 1month to1 year. Bone lesions, skin lesions and LAP were the common
presenting features. Skull was the major site of lytic lesions 10(47.6%) patients. Tissue biopsy
and/or aspiration were the main diagnostic procedures. Twenty patients treated by different
combinations of chemotherapy. Ten patients survived (50%), and the mean time of follow up
was 28 months.
Conclusion : The study showed a relatively high incidence of advanced (III and IV) stages of
disease 12 patients (57.1 %) with subsequent poor outcome and survival.
Recommendation : Long term follow-up by a multidisciplinary care team is required

Abdominal Operations without Nasogastric tube :A major advance inmodern surgery


Background: Routine use of nasogastric tubes, after abdominal operations, is intended to
hasten the return of bowel function, prevent pulmonary complications, diminish the risk of
anastomotic leakage, increase patient comfort and shorten hospital stay. Aim of this study is to
evaluate the efficacy of routine nasogastric decompression after abdominal surgery, in
achieving each of the above goals.
Patients and methods:Two hundred and twelve patients having abdominal operations of any
type, emergency and elective have been followed prospectively over a period of three years (1st

December 2004 until end of December 2007) in Baghdad teaching hospital. Patients were
randomized into two groups. Group 1 had nasogastric tube inserted and kept in place until
intestinal function has returned. Group 2 had no nasogastric tube or immediately removed at
the end of the operation. Excluded from the study , were laparoscopic surgeries , gastric and
duodenal surgeries.
Results: There was earlier return of bowel function and shorter hospital stay in the non tube
group. There were no significant statistical differences concerning the occurrence of
postoperative vomiting, pulmonary complications, anastamotic leakage and wound dehisence.
Conclusions: Routine nasogastric decompression does not accomplish any of its intended
goals and so should be abandoned in favor of selective use of nasogastric tube.


Authors: Hnoosh.Adnan Husain *,
Pages: 308-311

Background: Venous thromboembolic (VTE) disease with i t ' s h i g h morbidity and
mo r t a l i t y is currently one of the most serious postoperative complication, (DVT) can lead to
fatal pulmonary embolism (PE) . or the development of post thrombotic syndrome.
Patients and methods: This is a prospective study which was carried on 85 patients had
s i n g l e lower l i m b open fracture with no other major i n j u r i e s in other si tes of body
(with the exception of superficial wounds or b r u i s e s ) .They were d i v i d e d i n t o groups
according to age, gender, weight, type of fracture, methods of immobilization, duration of
h o s p i t a l i z a t i o n , duration of operation. All the patients including asymptomatic patients
were subjected by the fourth postoperative day for duplex untrasonography study.
Results: The total number of patients with DVT that documented by Duplex study was 27
patients with in incidence of (31.76%), the incidence of DVT is higher in proximal lower
extremity fractures as around hip (45.45%) Versus (12.5%) in lower tibial fractures. the
incidence of DVT increased with increasing severity of open fracture; (50% in Gustilo type III
B. 10% in Gustilo type I).
Conclusion: Age, weight, female gender, and severe open fracture proximal part of the lower limb,
long hospitalization, prolong surgery are risk factors in the development of (DVT).

Gun shot of the spine Surgical out come and prognosis

Authors: Ali K. AL-Shalchy *
Pages: 312-316

Background: the management of gun shoot wounds of the spinal cords (G sws) is still a
debate whether to interfere surgically or not, the interferance is usually laminectomy & Bullet
Objectives: A comparative prospective study between surgical & non-surgical management of
G sws.
Methods: A case series study of (52) patients with G sws were managed by the neurosurgical
unit in Ibn Sinna hospital in Mosul. 27 patients surgery was done, 25 patients non-surgical
A comparative study done according to the surgical outcome, improvement, mortality between
the 2 groups in a mean follow up period of 4.5 months.
Results: The mean age was 35, (9-50 years) , mean follow up 4.5 months (3-7 months)no
patients with non-surgical treatment show any improvement while 10 out 13 of incomplete
injury show significant improvement by surgery, the mortality rate was also higher in the non-
surgical group.
Conclusion:Bullet in the spinal cord with partial injury of the cord should be removed with
decompression of the cord complete injury of the cord show poor prognosis with or without
surgical intervention.

A study of 124 with cases carpal tunnel syndrome

Authors: Ali K. AL-Shalchy
Pages: 317-320

Background: carpal tunnel syndrome (CTS) a relatively common disease affecting ♀ more than ♂, usually at the age between 40 -60 , diagnosed by EMG & NCS, treated when moderate to severe by surgical decompression of the median nerve. Objective: To study the role of surgery in the management of CTS. Patients & method: 124 patients collected from the neuro-surgical departments of the specialized surgical hospital from August 2001 till March 2007, all patients studied thoroughly regarding age, sex, associated diseases, clinical features, EMG studies, surgery & out come & follow up for at least one year. Results & discussion: there was around 2:1 ♀:♂ , with age predomena between 40-60 years. All the patients had pain (aching) & most of them numbness, & tingling and only 1/3 had atrophy of muscle of the hand all diagnosed by EMG & NCS, treated surgically results were good compared with other studies regarding complications & final out come. Conclusion: surgery for CTS is safe & successful surgery under meticulus procedure & appropriate choice of patients. Keywords: Carpal tunnel syndrome (CTS), Median n. surgical decompression



Background: The present study was planned to show the accuracy of clinical examination and
tympanometry in diagnosis of middle ear effusion.
Patients and Methods: The study involved 80 patients (160 ears )suspected to have otitis media
with effusion (OME) from different age groups ; 56 were males and 24 were females .
Clinical assessment for all patients included otoscopy , pneumatic otoscopy and audiological
assessment by using pure tone audiometry and tympanometry then comparing the results to
findings at myringotomy as the gold standard for presence or absence of fluid in the middle ear .
Results : Fluid whether serous or glue was found in 100 ears ( 62.5 %) where as sixty ears were
dry, sensitivity , specificity and accuracy of tympanometry were 90 % , 70 % and 85 %
respectively , and for clinical assessment were 82 % , 52% and 71 % respectively . A combined
clinical and tympanometry sensitivity and specificity were calculated and found to be 96 % and
92 % respectively.
Conclusion : clinical examination as a method for diagnosis of middle ear effusion depend on
experience of the examiner . tympanometry proved to be a reliable diagnostic tool for the
diagnosis of OME , it appeared significantly better at determining non effusion state.

The Effect of Amoxicillin-Clavulanate and Actifed Versus Actived Only in treatment of Otitis Media with Effusion


Background: Otitis media with effusion(OME)is a common cause of deafness in children with subsequent impairment of speech development and scholastic difficulties.Treatment remains controversial. Aim: To study the effect of amoxicillin-clavulanate in treatment of OME Patients and methods: A prospective study of a target sample consisting of sixty children under the age of 12 years presented with chief complaints duration for at least 6 weeks and on examination there were bilateral red and retracted tympanic membranes without oversized adenoids and no underlying causes require surgical correction e.g cleft palate.The patients were divided into two groups;group A which received Actifed for 4 weeks and group B which received Actifed +Amoxicillin-clavulanate for 4 weeks treatment course.After complete history and otolaryngological examination,all the patients were sent to x-ray of postnasal space( to exclude oversized adenoids),audiometry and tympanometry.Assessment was repeated at the end of 2 and 4 weeks of treatment course including audiometry and tympanometry.The response to treatment in group B was compared to that in group A at the end of 4 weeks treatment course.In this study,we refered to improvement in otoscopic findings and tympanometry results to show the response to 4 weeks treatment course. Results: Eight patients(25.81%)in group A have shown response to treatment at the end of 4 weeks treatment course,while the response in group B was seen in 15 patients( 51.72%). Conclusion: Amoxicillin-clavulanate has statistically significant effect in treatment of otitis media with effusion(OME)in short term follow-up and the clearance of middle ear efussion in response to amoxicillin-clavulanate indicates that bacterial infection may play a role in the aetiology of OME. Keywords: Otitis media with effusion,Amoxicillin-clavulanate,Tympanometry.

Intrauterine Insemination and Luteal Support TherapyOutcomes in Unexplained Infertility, Mild and Marked LutealDefective Infertile Women

Authors: Z. A. Kanan, --- A. A. Jabar --- S. A. M. Alansari
Pages: 332-339

Background: Inadequate secretory transformation of the endometrium resulting from
deficient ovarian progesterone secretion is a cause of infertility and recurrent abortion
in luteal phase defects (LPD) women. LPD are diagnosed in 20% of infertile patients
and 60% of patients with recurrent abortion and 50% of anovulatory women.
Aim : The objective of the present study was to compare pregnancy outcome following
sperm penetration assay (SPA), intrauterine insemination (IUI) and luteal support
therapy (LST) in infertile patients with unexplained infertility (UI) mild and marked
Materials and Methods: Men with normal semen analyses and positive sperm
penetration assay scores were included in this Study while those men with abnormal
semen and negative SPA score were admitted to 1C SI program in another study. The
patients were divided into three groups: first group n= 42 with UI without LPD, second
group n= 60 with mild LPD and third group n= 58 with marked LPD. Progesterone (P)
concentration was assayed on cycle day 21 and patients showing P concentration of <
3.50 ng/ml were considered to have marked LPD and those with <10 ng/ml were
considered to have mild LPD. All patients received clomiphene citrate, human
menopausal gonadotropin and human chorionic gonadotropin (HCG) for ovulation
induction. The patients received 1500 IU of HCG on cycle day 14, 17, 20 and 23 after
IUI. Beta-HCG test was performed two weeks after IUI and when the test was positive,
the patients continued to receive the HCG treatment every three days for a period of
three months.
Results: There were no significant differences in the SPA and semen analysis
parameters between the groups. The Progesterone concentration was significantly
different among the groups (18.4, 8.9, and 2.4 in the first and second and third groups
(P<0.05) respectively on cycle day 21 prior to ovulation induction. Two weeks
following IUI, the Progesterone concentration in the marked LPD group was
significantly lower compared to mild and unexplained infertility groups (13.5 versus
20.3, and 22.8 ng/ml, P<0.05, respectively). The pregnancy rate per cycle was 35.7% in
the unexplained infertility group and 40% in the mild LPD group and 31% in the
marked LPD group (P>0.05).

*IVF Center, Baghdad University, College of Medicine, Baghdad Teaching Hospital, Departments of
Obstecric and Gynecology and Physiology and Physiological Biochemistry, Baghdad, Republic of

Original Article
Fac Med Baghdad
2008; Vol.50, No.3
Received March 2008
Accepted Aug. 2008
J Fac Med Baghdad Conclusion: In conclusion, the use of IUI and luteal support therapy in the mild,
marked LPD infertile patients and unexplained infertility resulted in similar pregnancy rates.


Pre-operative anxiety in patients undergoing different types of surgeryComparative study

Authors: Abdul-Rasoul Al-Yasiri*,
Pages: 340-345

Background: Major life changes are among many factors that cause emotional arousal and
anxiety ,and one of these changes is surgery. emotional reactions to surgery have specific
effects on the intensity and velocity as well as the process of physical disease and on the
general state of wellbeing of the patient.
Aims: This study is aimed at determining the relationship between the nature, extent and
severity of preoperative anxiety and different types of surgery.
Methods: 150 patients 84 males 68 females awaiting different types of surgery at Al-Kindy
teaching hospital at the period from 1st
January to 1st
July 2008 were assessed for a clinically
detected preoperative anxiety in relation to different variable including sex, age, type of
surgery ,severity and the main fears related to the operation. Using general health
questionnaires ( GHQs ) followed by semi-structured interview based on DSM-IV
classification, and then mental state examination.
Results: The study indicated that preoperative anxiety is common and is more in females,
more in patients in their thirties and forties,it is in excess and is more sever in cardio-thoracic
and gastro-intestinal tract surgery and is at its lowest level and severity in ophthalmology and
ENT surgery. so also the fear of death is associated more with cardio-thoracic and GIT
surgery. Females had more anxiety in all types of surgery except cardio-thoracic surgery which
is more in males.
Conclusions: Prevalence of Preoperative anxiety is high and represents over 2/3 of the sample
and is more in rate and severity in surgery with uncertain outcome or being considered as
more risky by patients.
Recommendations: The need for further studies on the effects of this anxiety on the post
operative course and outcome, and the need for the training of paramedical staff in surgical
wards on preoperative anxiety and ways of its intervention.

Extracorporial Knots in Laparoscopic Surgery: Which, When, and How


Despite recent advances in both suture welding and knotless anchor technology, knot tying will remain a necessary skill which the surgeon must master when performing suture anchor in laparoscopic surgery. There are an endless number of combinations of knots (sliding versus static, simple versus complex, etc.) and suture types (monofilament versus braided) to accomplish this task. Surgeons are familiar with knotting but seem not to be aware of the possibilities and impact of the techniques of capsizing, flipping, and flyping knots. (1) Capsizing refers to changing or perverting a flat knot’s geometry under asymmetric stress. The simplest examples of this is the change of the overhand knot into a half-hitch by putting more tension on its one end than on the other (Fig. 1A). (2,3,4) Flipping the knot means to interchange the standing part and working end of the suture, thereby relocating the knot from one end of the suture to the other.(5) The half-hitch can be flipped easily between both ends of a suture (Fig. 1B). Flyping (that rhymes with “typing”) is an archaic Scottish word that was used to describe the peeling off of a very wet glove of the hand, thereby changes its configuration from a righthand glove to a left-hand one. (6,7,8) . The Scottish physicist Peter GuthrieTait (1831- 1901) introduced flyping as a knotting term, in the late-19th century, to define this “turning outside in” deformation process of the geometry of knots. (9) An illustrative example of flyping is the change of a series of turns of the working end around the standing part, into the proper blood knot geometry by drawing the proximal turns over the distal ones (Fig. 1C). * Lecturer of Surgery, Dep. Of Surgery, College of medicine, Baghdad University, Iraq (7) Ignorance about the techniques of capsizing, flipping, and flyping resulted in the introduction of many allegedly new sliding endoscopic or arthroscopic knots that merely represented configurations of long-known fishing, sailing, or rigger knots. A knot should secure tissue approximation, simple, easy, quick, and reliable. The aim of this article review is to determine which hand tied knot configuration, suture size, and suture type that would be safe in laparoscopic surgery. Figure


Forensic Histopathological Approach to Electrocution


Background: Few Studies had been done on the role of histopathology in the medico-legal
diagnosis of Electrocution even abroad.
Aim of the study: To determine the main histopathlogical features in cases of electrocution
especially at the entry site of the electrical current which help in the diagnosis of those cases.
Methods: A full medico-legal autopsy had been done on 64 cadavers of persons died as a
result of electrocution chosen randomly out of a total number of 144 cases of electrocution
during the year 2005 in the medico-legal institute of Baghdad including histopathological
examination by ordinary method of different specimens from those cadavers at histopathology
department of the mentioned institute to reach the aim of this study.
Results: Electrocution constituted only 1.4% of all causes of death during the year 2005 in the
medico-legal institute of Baghdad. Males were more than females in a ratio of 2:1. The most
affected age group was 30- 39 years old. In 62% of the case the entry of the current was with
no exit. In 46.9% of the cases the entry site was in the form of charged centre surrounded by
gray elevated area and took other shapes in the rest of the cases. Microvesicural formation was
the commonest histopathological finding in the skin. Pulmonary edema was the commonest
histopathological finding in the lung.
Conclusions: Although they are non specific, histopatological features could help the forensic
pathologist in the medico-legal diagnosis of electrocution in addition with other findings
especially in cases with less typical gross features or with incomplete information about the
case, in addition to other conclusions of the study.

Male Breast Lesions: A review of 124 cases diagnosed by Fine Needle AspirationCytology


Background:Gynecomastia and breast cancer are the two most common diseases of the male
breast. Most other diseases found in male breast arise from the skin and subcutaneous tissues.
Male breast cancer is relatively rare, in contrast to gynecomastia, which is relatively common.
Objectives: The aim of this report is to determine the prevalence of the different breast
lesions among males; based upon the findings of fine needle aspiration cytology .
Patients and method:This study was carried out within the Main Referral Training Center
for Early Detection of Breast Tumors, Medical City Teaching Hospital, Baghdad (from the
beginning of January 2003 till the end of November 2007). One hundred twenty four males
presenting with different breast lesions were included; all were subjected to physical breast
examination, ultrasonography of the breast and fine-needle aspiration.
Results:Pathologically, 112 cases (90.3%) were diagnosed as benign lesions, including: 103
cases (83.1%) of gynecomastia, and 9 cases (7.2%) of other miscellaneous benign lesions: six
cases (4.8%) diagnosed as inflammatoty conditions [three cases of acute mastitis and three
cases of suberolar abscess], two cases (1.6%) diagnosed as granlomatous mastitis, and one case
(0.8%) as lipoma. On cytological examination, 14 cases (13.6%) of gynecomastia showed
varying degree of cellular atypia. Breast cancer was diagnosed in twelve patients (9.7%); all
were infilterative ductal carcinoma. The mean age of patients with gynecomastia was 20.3
years, while it was 61.8 years in breast cancer patients. Sixty six cases (53.2%) of male breast
masses were located within the left breast, 47 cases (37.9%) were located within the right
breast, while eleven cases (8.9%0) were bilateral (all were gynecomastia). The chief
complaints of patients with gynecomastia were as follows: painless mass in 38 cases (30.7%),
painful mass in 45 cases (36.3%), pain without mass in 13 cases (10.5), while evidence of
bilateral swelling was observed in seven cases (5.6%). Ten patients (8.1%) with breast cancer
presented with painless mass, while in only two (1.6%) the chief complaint was painful lump.
On ultrasonographic examination of patients with gynecomastia, 58 conditions (46.7%)
presented with proliferation of fibroglandular tissue (no definite mass), 35 conditions (28.2%)
showed well defined discoid lesions, while in ten cases (8.1%) the findings revealed ill defined
retroareolar masses. On the other hand, in patients diagnosed as having male breast carcinoma,
the ultrasound findings showed ill defined eccentric masses in eight cases (6.5%) and multiple
masses in four (3.2%).
Most cases of gynecomastia were idiopathic since patients gave no history of hormonal therapy
or exposure to other relevant risk factors.
Conclusions:Most palpable masses in the male breast are due to gynecomastia followed by
breast carcinoma. Because both present clinically as palpable masses, fine-needle aspiration
cytology is extremely useful for the diagnosis.



Background: New data suggests that joint damage in Knee Osteoarthritis (KOA) may be
caused by systemic factors like adipose tissue products; Adipokines, which may provide a
metabolic link between obesity & KOA. Recently, one of the known adipokines named
LEPTIN has been linked to KOA because it can be detected in serum & synovial fluid of
patients with KOA.
Objective: To evaluate the contribution of Leptin & serum lipids to the pathophysiology of
Osteoarthritis in Iraqi patients with Knee OA.
Subjects& Methods: The study was carried on 90 subjects divided into four groups:
Knee Osteoarthritis cases group (n=60).
Control group (n=30).
Obese subjects group (n=60).
Non-obese subjects group (n=30).
KOA cases were diagnosed clinically whereas obesity was specified by BMI ≥25kg/m2. For
all subjects studied measurements of fasting serum leptin and lipid profile have been done.
Results: Mean serum leptin level was significantly higher in KOA cases compared to control
group (P<0.001), and higher in obese than non-obese subjects (P<0.001). Serum leptin level
also showed a strong positive correlation with BMI (r=0.501, P<0.01).
Conclusions: Leptin may play an important role in the pathogenesis of KOA. In addition
abnormal lipid profile and obesity are important risk factors for KOA.

Resistin , Insulin resistance and BMI in type 2 diabetes mellitus and healthysubjects.


Background : Obesity and insulin resistance have been quite well recognized as fundamental
and leading causes of major health issues such as diabetes, hyperlipidemia, hypertension, and
cardiovascular diseases. Abdominal obesity, particularly visceral adiposity is considered to
play a major role in causing insulin resistance and type 2 diabetes mellitus , T2DM
The resistin is considered one of the causes of insulin resistance which lead to
hyperinsulinemia and a decrease in the quantitative insulin sensitivity check index (Quicki)
which has been recently reported to be a useful marker of insulin resistance in patients with
Objective : The aim of the present study is to find the relationship between resistin and
obesity as modulated by T2DM.
Subjects and methods : The study involved 50 patients with T2DM with age range of 30 -70
years , and 30 healthy subjects ( control group ) of matching age and sex.
Ten mLs of blood were collected from each patient and normal control subject after an
overnight fast . One mL. was kept in an EDTA tube for mesureement of glycated Hb ( HbA1c)
and the rest was allowed to clot , centrifuged and serum was divided into aliquots . Some
was kept at (- 20
C ) for measurement of resistin and insulin ( by enzyme linked
immunosorbant assay , ELISA) and the rest for measurement of glucose , urea and creatinine (
by the available routine laboratory tests ) at the same day of collection.
Results showed a significant rise in serum resistin in the obese diabetic patients as compared
to the non obese patients. There are significant correlations between resistin and each of insulin
resistance ( Quicki ) and degree of obesity (BMI) .
Conclusion : Resistin & insulin resistance are significantly affected by BMI in diabetic
patients only and not in the control group which implies that the obese control subjects didn’t
have insulin resistances enough to show any change in resistin level. This confirms the
synergistic effect of the obesity and diabetes on resistin level, while no effect of the disease per se could be detected from the present study.

Effect of aging on growth hormone-leptin axis in normal andobese healthy subjects


Background: Growth hormone is a hormone responsible for the normal body
growth and development by stimulation protein production in muscle cells and
energy release for breakdown of fat. On the other hand leptin is a newly discovered
hormone that is mainly synthesized in adipose tissues it decreases food intake by
causing satiety and promoting energy combustion . Both aging and obesity are
associated with a reduction in growth hormone secretion. In the mean time obese
humans have increased circulating leptin.
Objective: The aim of this paper is to shed light on the contribution of these two
hormones in the mechanism of aging process in an attempt of improving this
process for a better life at old ages.
Subjects and methods: Two hundred and seventy healthy subjects aged 25-64
years old participated in this study. The subjects' were divided into four groups
according to their ages and to three groups according to their weights. Urine
analysis from each subject was carried out to exclude diabetes and renal failure.
Sera from blood samples were used to carry out certain biochemical parameters and
hormone (growth hormone and leptin).
Results: The results obtained show a decrease in the level of growth hormone with
progression of age. In the mean time there is an increase in the level of serum leptin
with the advancement of age. Aging is usually associated with adiposity. Increasing
fat with age is probably multifactorial one potential mechanism for that is reduced
leptin transport across blood-brain barrier..
Conclusion: The increase in leptin level which was observed in elderly age group
and obese group suggest that the associated decrease in growth hormone serum
level is related to obesity in general and in particular to the aging process.


growth hormone --- leptin --- obesity --- aging.

Measurement of extracellular fluid compartment volume using inulin


Background: There is a need to find methods to assess the size of the extracellular fluid (ECF) volume without involving radioactive tracers. For this purpose, the simple delusion method was used to measure the ECF in rabbits and the inulin which is a polysaccharide was used as a marker of ECF measurement. Methods: 18 male rabbits were used in this study. 8 of these animals were bilaterally nephroctomized to calculate the exact time to get diffusion equilibrium time after a bolus dose of inulin at a dose of 25mg/kg of a solution of inulin 10 mg/ml. intravenously. The blood samples were taken after 1, 15, 45, 60, 90, 120, and 180 min. Results: ECF volume was about 144.5 to 149.7 ml/kg depending on the inulin concentration changing with time because the equilibrium time of inulin and the ECF could not be obtained to the end of the experiment. Conclusion: The inulin takes a space in the body fluids differ than the true ECF volume. It is better to use the term "inulin space" to reflect such measurements rather than the ECF volume. Key words: inulin, extracellular volume.

Anti-Liver membrane Antibody predict outcome of Autoimmune Hepatitis


Background: Autoantibodies against liver membrane are the specific
autoantibodies found in AIH. Cytochrome P450 1A2 has been identified as the
target autoantigen for these autoantibodies
The aim of the study : is to evaluate the prevalence and clinical relevance of
Methods: The study was performed on 73 Iraqi patients with chronic active hepatitis
(CAH) of unknown cause , attending the teaching hospital for gastroenterology and
liver disease in a period between November 2003 and July 2004. Anti-liver membrane
antibodies were studied by IFA technique.
Results: LMA was detected in the sera of 28(57.14)and 3(37.5%) patients with type 1
and type 3 AIH respectively, but never in the sera of healthy group .
Conclusion: It was concluded that LMA is present in type-1 and type-3 AIH but not in
sera of patients with type-2 or in healthy control group.


Table of content: volume:50 issue:3