Table of content

Iraqi Academic Scientific Journal

المجلة العراقية للاختصاصات الطبية

ISSN: 16088360
Publisher: The Iraqi Borad for Medical Specialization
Faculty:
Language: English

This journal is Open Access

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Table of content: 2012 volume:11 issue:2

Article
Fibroepithelial Tumors of Female Breast: A Review of 250 Cases of Fibroadenomas and Phylloides Tumors.

Authors: Sazan A. Al-Atrooshi
Pages: 140-145
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ABSTRACT: BACKGROUND: Fibroepithelial tumors of the breast including fibroadenomas and phylloides tumors arise from epithelial and stromal components of the terminal duct-lobular unit. Fibroadenoma is the commonest benign neoplasm of the female breast. These tumors are found as early as puberty. Mammary phylloides tumors are uncommon stromal-epithelial neoplasms and are divided into benign, borderline malignant and frankly malignant groups on the basis of their histological features. OBJECTIVE: The aim of this study is to evaluate the role of morphologic diagnosis in a series of fibroepithelial (biphasic) tumors of the breast including fibroadenoma and phylloides tumor, highlighting the morphological and Histopathological variants of fibroadenoma, and the most recent histological classification criteria of phylloides tumors. PATIENTS AND METHODS: This is a retrospective study including 250 cases of fibroepithelial tumors of the female breast, from October 2007 to September 2008. Cases were taken from private laboratories. All cases were excisional biopsy, the specimens were already fixed in 10% formalin and paraffin embedded. Sections of 4 microns were made from the paraffin blocks and stained with hematoxyllin and eosin stain and examined microscopically. RESULTS: Two-hundred and fifty cases of mammary fibroepithelial tumors were reviewed in this study. The age of the patients ranged between 14-49 years, and the tumor size ranged between 1.5-20 cm. The cases were histologically classified into: 220(88%) cases of fibroadenoma(FA) and 30(12%) cases of phylloides tumor(PT). Additional morphological features of fibroadenoma were: fifteen(6.8%)cases juvenile fibroadenoma, infarction in eight(3.6%) cases, lactational changes in ten(4.5%) cases, multinucleated giant cells in the stroma in six(2.7%) cases, prominent myxoid changes in three(1.4%) cases, features of fibrocystic changes in the surrounding in 14(6.4%) cases, cellular stroma in eight(3.6%) cases, apocrine metaplasia in 26(11.9%) cases, hyalinization and calcification of the stroma in 14(6.4%) cases, presence of adipose tissue , muscle or cartilage in 18(8.2%) cases, atypical epithelial hyperplasia in four(1.8%) cases, and ordinary fibroadenomas (non-otherwise specific) in 94(42.7%) cases. Multiple fibroademnomas were found in 20(9.1%) cases. Histological classification of the phylloides tumors showed 20(66.7%) benign cases, six(20%) cases borderline malignant and four(13.3%) malignant cases. CONCLUSION: Fibroadenoma is the commonest fibroepithelial tumor of female breast, phylloides tumor is an uncommon neoplasm which is usually benign but malignant variant exists.


Article
Real Time PCR as a Diagnostic Tool for HBV Infection in Iraq

Authors: Mohammed Ghanim
Pages: 146-150
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ABSTRACT : BACKGROUND: HBV infection is a worldwide infectious disease that acutely infects 2 billion yearly, thus finding a precise, accurate and sensitive diagnostic test for this infection is highly advisable. Real Time PCR has been introduced to achieve that mission. OBJECTIVE: Confirm the role of Real Time PCR as a precise tool for diagnosis of HBV infection in Iraq. PATIENTS AND METHODS: In this study, 40 patients of HBV with HBs Antigen positive serological test and 20 individuals with HBs Antigen negative were selected to be the material of the study and they were tested by Real Time PCR to estimate the exact amount of HBV genome in their blood. RESULTS: All the cases with HBs Antigen positive have had viral load with different values and no case with HBs Antigen negative have been found to have any viral element. CONCLUSION: Real Time PCR is useful and precise tool for the diagnosis and monitoring of patients with HBV infection and further studies are required to find a useful classification of the viral load and a correlation need to be found between viral load and the serological panel and especially HBe Antigen and HBe Antibody

Keywords

real time pcr --- hbv --- diagnosis


Article
Serum Anti-Cyclic Citrullinated Peptide (Anti_CCP) Antibody Level in Rheumatoid Arthritic Patients with and without Nodal Osteoarthritis

Authors: Ahmed A. Gassid
Pages: 151-156
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ABSTRACT: BACKGROUND: Rheumatoid Arthritis (RA) is chronic systemic inflammatory disease affects synovial joints , articular structures and extra articular , the prevalence rate occurs aprox in about 1% of population Anti citrullinated peptide/protein antibody (Anti-CCP) antibody are autoantibodies(antibodies directed against one or more of the individuals own proteins) frequently detected in RA patients during inflammation. citrulline is incorporated enzymatically into proteins . The current study is a trail to ensure that Anti-CCP marker is more specific and sensitive for diagnosis of RA patients and to detect the effect of the presence of other disease like NOA on Anti-CCP value OBJECTIVE: Evaluation of Anti-CCP Ab level in RA patients with and without NOA.The serum level of Accp_Ab is estimated using ELISA technique in patients with RA and NOA. SUBJECTS AND METHODS: The studied group includes 30 RA patients (24 females and 6 males), who fulfilled four or more of the 1987 ACR criteria compared with 30 RA+NOA patients (23 females and 7 males) also fulfilled four or more of the 1987 ACR criteria for the classification of Rheumatoid arthritis and nodal osteoarthritis group. Blood samples were taken from three groups to analyze and measure the serum levels of Anti-CCP. RESULTS: Result of investigations were compared with that for the 30 apparently healthy control individuals who matched the patient´s group in age and sex. The result of the study showed that majority of patients is females (80%) for RA patients and (76.6%) for RA+NOA patients (with females: males 4:1 & 3.28:1 for RA and RA+NOA respectively). Moreover, the mean age for RA, RA+NOA and control groups are: 48.03±12.95y, 51.3±11.8y and 37.43±12.57years respectively. It was observed from the result that there is a higher positivity of Anti-CCP in the patients sera( 76.7% for RA+NOA cases and 70% for RA cases) in comparison with healthy control group (0.0%) so there is highly significant difference (p<0.001). While the quantitative estimation of Anti-CCP antibodies showed that its level was higher among sera of RA+NOA patients in addition to RA patients (53.59±33.29 RU/ml and 52.28±48.99 RU/ml respectively) in comparison with healthy control group 2.88±2.50 RU/ml. CONCLUSION: We found that Anti-CCP is a good & specific marker for diagnosis of RA & RA can be differentiated from other disease by measuring this marker. Moreover, Anti-CCP Ab level in RA patients does not significantly affected by the presence of NOA.


Article
Ki-67(MIB-1) and Progesterone Receptor in Meningioma An Immunohistochemical Study

Authors: Wahda Mohammed Taib Al- Nuaimy
Pages: 157-167
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ABSTRACT: BACKGROUND: In meningioma the tumor grade, subtype, and extent of surgical resection are strong prognostic factors, the growth of this tumor is still unpredictable, and additional prognostic markers are needed. Many studies have shown that the detection of the proliferative potential of meningioma by Ki-67 (MIB-1) and the detection of the progesterone receptor might predict the natural history of tumor and patient survival. OBJECTIVE: To evaluate the proliferative fraction Ki-67 (MIB-1) and progesterone receptor in meningioma, To correlate the expression of these two markers with various clinico- pathological parameters, To compare these results with other studies . PATIENTS AND METHODS: This is a prospective study, in which 50 cases of meningioma were collected in Nineveh province. These cases were examined immunohistochemically. The results of these two markers were correlated with various clinico- pathological parameters. RESULTS: The mean age of all cases was 46 years. There were 16 male and 34 female patients. According to the W.H.O 2000 classification, there were 84% grade I, 10% were grade II and 6 %were grade III. Only 14% of the patients had a history of recurrence. Progesterone receptor was positive in 72% of all cases. Significant relation was observed between the progesterone receptor and the patients age .It was significantly higher in female than male. A significant relationship was found between progesterone receptor with grade and histological types. Thirty three out of 43 cases without recurrence had positive progesterone receptor. The mean±Standard deviation (SD) of Ki-67 Labeling Index (Ki-67 LI) was 2.7±4.2%. No significant relation was found between the Ki-67 LI and patients age. The male patients had a higher Ki-67 LI than that of the female. Significant relation was found between Ki-67 LI and the grade of meningioma . The mean of Ki-67 LI in the recurrent cases was higher than in non recurrent cases. An inverse relationship was found between Ki-67 LI and progesterone receptor . CONCLUSION: Progesterone receptor showed a significant relation with the age and histological types. Ki-67 LI had a direct significant association with the grade and the recurrent cases., while inverse relation was observed between the progesterone receptor with the grade and the recurrent cases. An inverse relationship was observed between the progesterone receptor and Ki-67 LI.


Article
Inhibitory Effect of Lactobacilli Filtrate on Klebsiella Pneumoniae Biofilm

Authors: Harith J.F. Al-Mathkhury
Pages: 168-179
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ABSTRACT: BACKGROUND: The formation of biofilms by K. pneumoniae is thought to protect the bacteria from antibiotics since these entities are highly resistant to such antimicrobial agents. OBJECTIVE: Investigating the role of Lactobacillus spp. supernatant in eliminating K. pneumoniae biofilms. METHODS: Three hundred and twelve specimens of urine, wounds and sputum were collected from patients attending five hospitals in Baghdad. All specimens were identified using biochemical tests and Api 20 E system. The ability of K. pneumoniae isolates to produce biofilm were evaluated using crystal violet staining technique in pre-sterilized 96-well polystyrene microtiter plates. The effect of MIC of Amikacin and Gentamicin was assessed on biofilm. The ability of acid and alkaline supernatants of Lactobacillus acidophilus and L. fermentum to inhibit planktonic as well as biofilm of K. pneumoniae K14, K15, K17 and K19 isolates were separately tested. RESULTS: Twenty two (39.29%) K. pneumoniae isolates were considered as high biofilm producers. Moreover, K. pnumoniae isolates; K14, K15, K17 and K19 produced the thickest biofilm. All biofilms treated with Amikacin and Gentamicin developed a presence of live cells when cultured on plate count agar. Neither neutralized supernatant of Lactobacillus acidophilus (Lb1) and L. fermentum (Lb2) nor sterile MRS broth has an effect on planktonic K. pneumoniae K14, K15, K17 and K19 isolates. Yet, results showed that lactobacilli acid supernatant developed a marked inhibitory effect. Significant differences (P<0.05) were found in O.D. and viable count between pre and post treatment of K. pneumoniae K14, K15, K17 and K19 biofilms with acid supernatants of Lb1 or Lb2. Unlike the Amikacin and Gentamicin treatment which left live bacterial cells, Lactobacillus supernatant left no live cells except for two cases; Lb1 against K17 and Lb2 against K15. CONCLUSION: Lactobacillus supernatant is a potent antimicrobial agent against K. pneumoniae biofilms


Article
Inhibitory Effect of Lactobacilli Filtrate on Klebsiella Pneumoniae Biofilm

Authors: Harith J.F. Al-Mathkhury
Pages: 168-179
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ABSTRACT: BACKGROUND: The formation of biofilms by K. pneumoniae is thought to protect the bacteria from antibiotics since these entities are highly resistant to such antimicrobial agents. OBJECTIVE: Investigating the role of Lactobacillus spp. supernatant in eliminating K. pneumoniae biofilms. METHODS: Three hundred and twelve specimens of urine, wounds and sputum were collected from patients attending five hospitals in Baghdad. All specimens were identified using biochemical tests and Api 20 E system. The ability of K. pneumoniae isolates to produce biofilm were evaluated using crystal violet staining technique in pre-sterilized 96-well polystyrene microtiter plates. The effect of MIC of Amikacin and Gentamicin was assessed on biofilm. The ability of acid and alkaline supernatants of Lactobacillus acidophilus and L. fermentum to inhibit planktonic as well as biofilm of K. pneumoniae K14, K15, K17 and K19 isolates were separately tested. RESULTS: Twenty two (39.29%) K. pneumoniae isolates were considered as high biofilm producers. Moreover, K. pnumoniae isolates; K14, K15, K17 and K19 produced the thickest biofilm. All biofilms treated with Amikacin and Gentamicin developed a presence of live cells when cultured on plate count agar. Neither neutralized supernatant of Lactobacillus acidophilus (Lb1) and L. fermentum (Lb2) nor sterile MRS broth has an effect on planktonic K. pneumoniae K14, K15, K17 and K19 isolates. Yet, results showed that lactobacilli acid supernatant developed a marked inhibitory effect. Significant differences (P<0.05) were found in O.D. and viable count between pre and post treatment of K. pneumoniae K14, K15, K17 and K19 biofilms with acid supernatants of Lb1 or Lb2. Unlike the Amikacin and Gentamicin treatment which left live bacterial cells, Lactobacillus supernatant left no live cells except for two cases; Lb1 against K17 and Lb2 against K15. CONCLUSION: Lactobacillus supernatant is a potent antimicrobial agent against K. pneumoniae biofilms


Article
A Prospective Study for Functional Outcome of Tension Band Wiring in Treatment of Proximal Humerus Fractures Neer’s Type III

Authors: Ahmed Alkhuzai
Pages: 180-186
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ABSTRACT: BACKGROUND: Many methods used for treatment of proximal humerus fractures, in this study used the tension band wiring in treatment of proximal humerus surgical neck as figure of 8 in treatment of these fractures. OBJECTIVE: To prove the advantages of tension band wiring in treatment of proximal humerus fractures. Patients& Methods: From December 2003- December 2006, 16 patients with closed two part surgical Neck proximal humerus fractures Neer’s type III were admitted to the department of orthopaedic surgery and traumatology in Alkarama General Hospital &Sulaimania Teaching Hospital. All patients were males mean age 32 years, all patients were treated by figure –of- 8 tension band wiring techniques with minimal osteosynthesis in fixation, surgical deltoid splitting approach without disturbing the Vascularity of the humeral head, but with a stable secure fixation. RESULTS: The out come of this method of treatment was reviewed monthly for 12 months. The results were evaluated according to the Neer’s criteria and scores. The final follow up 13 patients out of 16 (81.25%) achieved excellent and satisfactory results, 3 patients (18.75%) was rated as unsatisfactory result. So the final outcome according to Neer’s scores was good and excellent result. CONCLUSION: Two parts displaced proximal humerus fractures in young adults patients Treated by open reduction with fixation by tension band wiring has improved the functional outcome results of these type fractures


Article
Prevalence of Abnormal Ankle –Brachial Index in Iraqi Patients with Systemic Lupus Erythematosus

Authors: Ziad S. Al-Rawi
Pages: 187-192
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ABSTRACT: BACKGROUND: Accelerated atherosclerosis is a well-recognized complication of systemic lupus erythematosus (SLE). Its etiology is a multifactorial and several methods may be used to detect the presence and severity of peripheral arterial disease (PAD). OBJECTIVE: To assess ankle brachial index (ABI) in Iraqi patients with SLE, and to evaluate predictors of this relationship. PATIENTS AND METHODS: Forty three Iraqi SLE patients and 50 healthy controls were included in this study. Full history was taken and complete clinical examination was done for all individuals in both groups. Disease characteristics [age, sex, body mass index (BMI), duration of disease, SLE disease activity index (SLEDAI), smoking history, family history, hypertension, hyperlipidemia, thrombosis, Raynaud’s phenomenon and drugs used] were also documented. Laboratory analysis included complete blood count, general urine examination, serum lipid profile, fasting blood sugar, thyroid function tests, anti-double stranded deoxyribonucleic acid (anti-ds-DNA), complements components and anti-phospholipid anti-bodies. Individuals in both groups were assessed using the ABI. The ABI was measured using a contour wrapped 12cm cuff attached to a mercury sphygmomanometer and 5-10 MHz Doppler in the arms and legs; a ratio of ≤0.9 was considered abnormal. Abnormal ABI was categorized as mild, moderate and severe. RESULTS: Seven (16%) Iraqi SLE patients have abnormal ABI compared with 0% of controls (P=0.010). All patients were of mild abnormal ABI(P=0.003).There was significant association between abnormal ABI and: sex, smoking history, and cyclophosphamide therapy (P=0.000, P=0.001, P= 0.020 respectively) but there was no significant association between abnormal ABI; and other patients’ characteristics[ age, BMI, duration of disease, SLEDAI, family history, hypertension, thrombosis, Raynaud’s phenomenon, or drugs used (steroid, mycophenolate mofetil, hydroxychloquin, non-steriodal anti-inflammatory drugs and statins)] (P=0.579, P=0.754, P=0.823, p=0.148, P=0.655, P=0.233, P=0.655, P=0.241, P=0.512, P=0.335, P=0.315, P=0.655 , P=0.185) respectively. CONCLUSION: Mild abnormal ABI occurs with high frequency (16%) in Iraqi SLE patients. Males, smoking history, and cyclophosphamide therapy are significant predictors


Article
Transcatheter Traetment for Native Aortic Coarctation in Adult (with and Without Stentining)

Authors: Sadiq Al-Hamash
Pages: 193-198
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ABSTRACT: BACKGROUND: Surgical repair was considered the conventional treatment for native aortic coarctation while balloon angioplasty emerged recently as an alternative to surgical repair and considered the treatment of choice in recurrent postoperative coarctation but its use with or without endovascular stent implantation for native coarctation remains controversial. OBJECTIVE: We sought to investigate the results of transcatheter treatment for native aortic coarctation in adults and compare the success rates and early complications rates between balloon angioplasty and self expandable stent. METHOD: Fifty one patients with native coarctation underwent transcatheter intervention in two different cardiac centers in Baghdad between January 2001 and July 2004 , 26 patients underwent balloon angioplastry alone while 25 patients had endovascular stenting for coarctation. Hemodynamic, angiographic and follow up data were reviewed and analyzed for each patient. RESULT: Tthe procedure acutely reduced the transcoarctation systolic pressure gradient from 68+/-23 to 7.5+/-11 mmHg with increase in minimal luminal diameter of coarct segment more than two folds post intervention. The immediate success rate was comparable in stent and balloon group (88% versus 84% respectively) .Nearly half of our patients became normotensive without antihypertensive medication before discharge .Minor complications found to be significantly higher among balloon group as compared to stent group 34% versus 28%. CONCLUSION: Balloon angioplasty with or without endovascular stenting is safe and effective non-surgical approach for native aortic coarctation in adult. Larger sample size and longer follow up are needed.

Keywords

coarctation --- angioplasty --- stent


Article
Electrocardiograph and Echocardiograph Electrocardiograph and Echocardiograph Electrocardiograph

Authors: Basil N.Saeed*
Pages: 199-204
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ABSTRACT: BACKGROUND: Rheumatoid arthritis (RA) is a systemic autoimmune disease with characteristic feature of persistant inflammatory synovitis in symmetrical distribution; it has a higher incidence of fatal and non-fatal cardiovascular events which account for half of all death in RA patients. OBJECTIVE: To study the cardiac involvement in long standing rheumatoid arthritis patients in comparison to healthy persons by electrocardiograph and echocardiograph. PATIENTS AND METHODS: A sample of 100 Iraqi patients with long standing rheumatoid arthritis and 100 healthy individuals who served as control group matched for sex and age were selected after exclusion of risk factors (hypertension, diabetes mellitus, smoking and previous cardiac problems), both groups were studied by electrocardiograph and echocardiograph under supervision of a cardiologist. RESULTS: There were a significant number of patients with rheumatoid arthritis having abnormal electrocardiographic findings 21(21%) in comparison to healthy persons 7(7%) (P-value 0.004), also there were significant number of rheumatoid arthritis patients with abnormal echocardiographic findings 36(36%) in comparison to healthy individuals 11(11%) (P-value o.ooo).while there were no significant association between disease duration and type of medications with cardiac abnormalities reported in this study. CONCLUSION: There is an increase of asymptomatic cardiac structural abnormalities in chronic rheumatoid arthritis patients in comparison to normal healthy individuals as detected by electrocardiograph and echocardiograph.


Article
Obesity and Asthma Severity Among Adults Presenting to the Out Patient Clinic

Authors: Hashim M. Al-Kadhimi
Pages: 205-210
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ABSTRACT: BACKGROUND: Recent studies have suggested a relationship between asthma and obesity. The risk for developing asthma increases with increasing obesity among individuals. Yet little is known about how obesity influences asthma. OBJECTIVE: To determine whether a relation of Obesity to asthma exists among adults presenting to the out patient respiratory clinic , and the correlation between Obesity and spirometric changes in patients with asthma. METHODS: A cross-sectional study was done for one hundred patients aged 17 to 70 years patients with asthma diagnosed by clinical and pulmonary function test , in the respiratory outpatient's clinic in AL Kadhmia Teaching Hospital. Collected from May to December 2010 The following parameters were assessed: Weight, height, body mass index, gender,spirometric parameters which includes of forced expiratory volume in 1 second (FEV1), forced vital capacity(FVC),FEV1FVC ratio, and forced expiratory flow50% (FEF50%) RESULTS: There were 100 asthmatic patients,32 male and 68 female. There age between 17-70 year, classified into four groups according to BMI. There was significant relation between obesity and asthma (p=0.03),this relation was statistically significant in female(p=0.003) but not in male. spirometry in male showed no statistically significant (p-value > 0.05) for FEV1, FVC FEV1FVC ratio, FEF50% in both non obese and obese, but in female statistically significant for FEV1FVC(p 0.05) ,FEF50% (p 0.036) , while no statistically significant for FEV1, FVC in both groups, for both male and female according to BMI there is statistically significant for FEF50% (p 0.015),while no statistically significant for FEV1FVC, FVC, FEV1 in both groups. CONCLUSION: There was a significant relation between asthma and obesity , in female ,but not in male. There is statistically significant difference for FEF50% ,and FEV1FVC in obese female .Also there is statistically significant difference for FEF50% in both male and female according to BMI.

Keywords

asthma --- obesity --- BMI


Article
Evaluation of Early Active Mobilization Protocol of Extensor Tendon Repair At Zone V, VI and VII

Authors: Azzam Raheem Abbas
Pages: 211-219
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ABSTRACT: BACKGROUND: Extensor tendon injuries are relatively common. The thin overlying skin makes the tendons vulnerable to sharp injuries. Yet tendon adhesions during the healing phase is a frequent outcome, it might limit the full recovery of the patient. OBJECTIVE: This prospective clinical study was done to evaluate the postoperative protocol of early active mobilization using simple, easy to made static splint. It provides the surgeon with guidelines to treat patients with extensor tendons injuries. It helps the patients to attain best results and least complications. PATIENTS AND METHODS: In this prospective study 27 cases of fresh injury of extensor tendon at zone V to VII were treated with primary repair (within 24 hour) or delayed primary in the Medical City teaching complex between March 2009 to March 2011. A protocol of early active mobilization was undertaken, using an easy to follow rehabilitation plan. RESULTS: Twenty seven patients included in this study, with age ranging between 20 – 60 years. All were assessed according to the Dargon criteria at the sixth postoperative week. The most common injury was caused by glass 74%. Patients were followed up to one year, and 63% of the patients had excellent RESULTS: The most common complication was tendon rupture in 4 cases, 14.7%. CONCLUSION: The early mobilization of repaired extensor tendon reduces the formation of adhesion as compared to rigid immobilization. We recommend the use of this protocol following extensor tendon repair in the hand at zone V, VI, and VII in cooperative patient .It will give fairly acceptable results.


Article
Dermis as an Interposing Graft for Reconstructing Peyronies Disease

Authors: Yasir Naif Qassim
Pages: 220-225
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ABSTRACT: BACKGROUND: Peyronies disease is an acquired fibrous plaque induced penile deformity,it has two phases;acute with painful erection and chronic with minimal pain but persistant penile curvature.Many conservative and surgical treatment modalities have been described.Plaque excision and dermal grafting has given promising results. OBJECTIVE: To evaluate the efficacy of plaque excision and dermal grafting in peyronies disease. PATIENTS AND METHODS: A prospective study was conducted on ten patients with chronic peyronies disease.All the patient underwent surgical excision of fibrotic plaque and dermal grafting.All the patients were evaluated postoperatively through regular visits for six to eight months to detect any recurrence or erectile dysfunction. RESULTS: The disease was more prevalent between ages of 40-55 years.All the plaques were located dorsally on the penile shaft except one which was dorsolateral.Five patients were complaining of erectile dysfunction preoperatively,two of them improved after surgery.Postoperative recurrence of fibrotic pluque involved only one patient. CONCLUSION: Fibrotic plaque excision and dermis grafting is an effective method on the long term with minimal associated complications.


Article
A Comparative Study of Laparoscopic Versus Open Appendectomy

Authors: Basher A. Abdul- Hassan
Pages: 233-237
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ABSTRACT: BACKGROUND: Laparoscopic appendectomy has gained popularity in recent years and has become one of the most widely performed procedures. However, it is not the universal gold standard as laparoscopic cholecystectomy for acute cholecystitis. This is, perhaps, due to the emergency nature of disease often operated by junior staff in odd hours when laparoscopic equipment, trained staff and supervision may not be available OBJECTIVE: To compare the results of open with laparoscopic appendectomy in terms of postoperative pain, rate of wound infection and hospital stay. PATIENTS & METHODS: This study was conducted in Al- Kadhmyia teaching hospital, over a period of six months from the 1st of October 2009 to the 1st of April 2010. Patients undergoing surgery for acute appendicitis were randomly assigned into one of the two groups (A or B) after obtaining written and informed consent. In Group-A patients underwent open appendectomy and in Group B laparoscopic appendectomy was performed. Post operatively pain chart, days of hospital stay and wound infection was recorded. RESULT: Sixty patients (38 male, 22 female), with clinical diagnosis of acute appendicitis based on Alvarado score of six and above, were included in the study. They were randomized into 2 groups of A and B with 30 patients in each group. Group-A comprised open appendectomy procedure and Group-B comprised laparoscopic appendectomy. Comparison of postoperative pain by visual analogue scale was significantly low in Group B, compared with Group A, on day 0, 1 and 2. Number of days in Hospital was 4.1±0.8 days in Group A and 1.5±0.06 days in Group B. None of the patients in Group B, while 8 (26.67%) patients in-Group A, developed postoperative wound infection at 1 week follow up. CONCLUSION: Laparoscopic appendectomy is safe and effective. Postoperative pain, hospital stay and wound infection were significantly lower after this mode of surgery


Article
Abdominal Transperitonial Approach in Management of Vesicovaginal Fistula in Iraqi Patients

Authors: Mohammed Jabbar AL-Rubai
Pages: 238-241
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ABSTRACT: BACKGROUND: Vesicovaginal fistula (VVF) is an abnormal fistulous tract extending between the bladder and the vagina In addition to the medical sequel; they often have a profound effect on the patient's emotional well-being and social life. OBJECTIVE: Is to evaluate success of abdominal approach in treating vesicovaginal fistula in Iraqi patients. METHODS: Retrospective comparative study was carried out on fourteen Iraqi patients suffering from vesicoveginal fistula according to inclusion criteria and followed for 3-12 months after tranabdominal repair with omental interposition flap. RESULTS: Twelve (85%) patients have obstetrical causes while two (15%) patients have gynecological causes. Eight (75%) patients aged between 21-30 years while six (43%) patients aged between 31-45 years. Eight (57%) patients are primigravidae. Site of fistula either spratrigonal[seven cases (50%)] or infratrigonal [seven cases (50%)]. Only one of infratrigonal fistula is close to ureteric orifice. Size of fistula either <1cm [seven cases (50%)] or between 1-2 cm [five cases (36%)] or between 2.1-3 cm [two cases (14%)]. Twelvecases (85%) have correct repair. CONCLUSION: The results of suprapubic closure of a vesicovaginal fistula are very good


Article
Diffuse Parenchymal Lung Diseases, Clinical Features Radiological Findings and the Diagnostic Yield of Open Lung Biopsy

Authors: Kassim Mohammad Sultan
Pages: 242-245
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ABSTRACT: BACKGROUND: Diffuse parenchymal lung diseases are rare , poorly understood and had not been studied in Iraq . OBJECTIVE: To evaluate the clinical features and radiological findings of diffuse parenchymal lung diseases in relation to open lung biopsy. SUBJECTS AND METHODS: Twenty eight patients who were suspected to have diffuse parenchymal lung diseases( regarding clinical features, pulmonary function testing , chest-x-ray and conventional computed tomography findings) were recruited from Baghdad Teaching Hospital from the 1st. Jan 2006 to 30th.June 2011 and were subjected to open lung biopsies which had been histopathologically studied. RESULTS: There were 16 (57%) males and 12 (43%) females, the mean age was 43.1±1.5 years, progressive dyspnea was the common presenting symptoms in 22 patients (78.6%) , dry cough was the presenting symptoms in 6 (21.4%)patients , restrictive lung defect was present in 26 (92.9% ) patients, bilateral fine basal crepetations were heared in 24 ( 85.7%) patients, clubbing of fingers was present in 17 (60.7%) patients ,chest-x- rays findings were: 24(85.7%) patients had mainly lower zone involvement and 18(64.3%) patients had reticular infiltrate .CT findings were : 20(71.4%) patients had basal infiltrate and11(39.3%) patients had subpleural involvement. Open lung biopsy results were : 11 (39.3%) patients had usual interstitial pneumonia (idiopathic pulmonary fibrosis) , 7 (25%) patients had desquamative interstitial pneumonia,and 2(7.1%) patients had nonspecific interstitial pneumonia 2 (7.1%) patients had non caseating granulomas. CONCLUSION: Dyspnea on excertion was a common presenting symptom. Bilateral fine basal crepetations were a common physical finding. Restrictive lung defect was the major finding in pulmonary function testing. Lower zone and basal infiltrates were common findings in chest-x-rays and conventional computed tomographies respectively. Idiopathic pulmonary fibrosis (usual interstitial pneumonia) was the most common type of diffuse parenchymal lung diseases, followed by desquamative interstitial pneumonia. Open lung biopsy gave a high diagnostic yield.


Article
Brachial Arteriovenous Fistula Flow and post Fistula Venous Diameter in HemoDialysis Patients

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ABSTRACT: BACKGROUND: An arteriovenous fistula must be able to sustain the flow demands of the hemodialysis machine; the flow rate in the fistula only has to be marginally greater than the demands of the blood pump. So fistula flow should be in the range of 600 to 700 mL/min. Overflow occurs when flow rate exceeds 20% of cardiac output. OBJECTIVE: Evaluation of arteriovenous fistula flow rate and post fistula venous diameter in patients on regular hemodialysis to highlight the prevalence of overflow fistula and its relation to gender, co-morbidities, signs and symptoms. PATIENTS AND METHODS: The measurements of fistula flow rate and post fistula venous diameter in a randomly selected sample of 43 hemodialysis patients (all are bracheocephalic AV-fistula) in the department of dialysis in al-Yarmouk Teaching Hospital in the period from the 1st of August 2010 till the 28th of February 2011. Statistical analysis using Chi-square test and Pearson correlation has been done via SPSS software version 17. RESULTS: From the 43 patients enrolled in the study, 31(72%) patients have a fistula flow rate over 1300 mL/min, overflow group; 12 (28%) patients have a flow rates within 1000 ± 300 mL/min, optimal flow group and none has a fistula flow rate less than 700 mL/min. There is a significant association between overflow fistula with (hypertension, the presence of peripheral cyanosis in the fistula corresponding hand, the occurrence of numbness in the fistula corresponding hand and the occurrence of dizziness during hemodialysis) and a strong linear correlation between the measurements of post fistula venous diameter and corresponding fistula flow rates, Pearson correlation coefficient (r) of +0.8005. CONCLUSION: Our study shows a high prevalence of overflow fistula in the patient sample, and this high flow rate is associated with significant complications


Article
Natural History of Symptomatically Treated Children with Cystinosis

Authors: Nariman Fahmi A.Azat
Pages: 254-257
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ABSTRACT: BACKGROUND: Cystinosis is an autosomal recessive disorder of lysosomal transport of cystine . Nephropathic (infantile) cystinosis is the most common and the most severe clinical expression of the disease . OBJECTIVE: To highlight the natural history of symptomatically treated children with cystinosis PATIENTS AND METHODS : A retrospective study was done on cystinotic patients who were diagnosed and treated symptomatically in children welfare teaching hospital in Baghdad from period Jun 2002 –July 2011. RESULTS: Twenty nine patients ,19 (66%)males and 10(34%) females who were diagnosed as cystinosis and treated symptomatically were included in the study; their ages ranged between (0.6 -12 ) years median 4 years . the age of onset of symptoms of tubular dysfunction ranged from (0.3-3.5 yrs) median (1.1 yrs.), positive family history of cystinosis was found in 11(37.9 %) cases and parents were consanguineous in 25 (86.2%) families. All patients presented with history of polyuria, polydypsia, anorexia, vomiting, constipation and failure to thrive. Rickets was found in 22(75%)and photophobia was found in 19 (65.5%) patients. Follow up data showed renal insufficiency in eighteen patients(62%) at a median age of 9(4-12) years ,hypothyroidism diagnosed in one patient(3.44%)at the age of 11 years , six (20.68%) patients died , three (10.3%)patients secondary to renal failure . CONCLUSION AND RECOMMENDATIONS: Cystinosis causes extensive morbidity and death in childhood and because of high rates of consanguineous marriages in our society , we encourage a high index of suspicion in infants presenting with fluid and electrolyte loss aiming at early diagnosis and treatment of cystinosis . leukocyte cystine levels is still needed to be available to confirm diagnosis in infants who have negative ocular examination .and to win in the fight against this terrible disease cysteamine treatment need to be available for these patients


Article
Comparative Study in Neonates with Septicemia Using Meropenem Versus Ceftriaxone Plus Vancomycin.

Authors: Huda Y Matloub
Pages: 258-265
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Abstract

ABSTRACT: BACKGROUND: Neonatal septicemia is an important cause of mortality in both developed and developing countries . The type and pattern of organisms that cause neonatal sepsis changes over time. In addition the causative organisms have developed increased drug resistance for the last two decades . OBJECTIVE: To compare the effectiveness and tolerability of two different antibiotic regimens in the initial treatment of suspected neonatal septicemia. PATIENTS AND METHODS: This is a controlled clinical trial on 80 neonates with a presumptive diagnosis of septicemia who were admitted to the children welfare teaching hospital of Baghdad from August 2010 to March 2011.Both early onset sepsis and late onset sepsis were included in this study. The diagnosis of probable sepsis was based on the presence of a repertoire of clinical symptoms and signs . Initial tests performed included complete blood count , CRP, and blood cultures. Neonates were randomly divided into two groups of forty neonates per each. The first group was given meropenem of 30mg/kg /dose every 12 hours , while the second group was treated by a combination of ceftriaxone 50mg/kg/dose every 12 hours plus vancomycin of 15mg/kg/dose every 12 hours. The duration of treatment was 7-14 days. RESULTS : The patients variables in the two treatment groups at entry were comparable. The most prevalent clinical features were reluctance to feed (83.75%), lethargy(70%) , pallor (47.5%), irritability (38.75%), and hypothermia(32.5%).Of the 80 neonates , 81.25% had positive CRP , 58.75% had abnormal WBC count(<5000 /mm3 or > 20000/mm3 ) , and 48.75% had positive blood culture for bacteria .Staphylococcus coagulase negative accounted for28.2% of the total isolates followed by E coli (23%) , Klebsiella pneumonia (20.5%), pseudomonas aeruginosa (17.9%), streptococcus (7.7%), and staphylococcus aureus (2.5%). The overall responses to treatment was significantly higher P<0.05 in the meropenem group with a cure rate of 87.5 % versus 67.5 % in vancomycin plus ceftriaxone . Neonates with early onset sepsis showed a significantly higher success rate (p<0.05) with meropenem than with ceftriaxone plus vancomycin (the cure rate 93.1% versus 60%)While there were no differences between the two treatment group regarding late onset sepsis 72.2 % versus 80 %. CONCLUSION: The most effective antibiotic for early onset sepsis in this study was meropenem, while it had equal effectiveness with the combination of ceftriaxone plus vancomycin against late onset sepsis.


Article
Ninety Degree Straight Leg Raising Hamstring Lengthening in Non-Ambulatory Patients with Cerebral Palsy.

Authors: Sameer A. Kitab
Pages: 266-273
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Abstract

ABSTRACT: BACKGROUND: A 90 degree straight leg raising hamstring lengthening was conducted in a consisted and prospective manner in non ambulatory children with Cerebral palsy. OBJECTIVE: A particular attention paid to evaluate clinical crouch recurrence, postoperative recurvatum, and overall improvement in functional capacity. PATIENTS AND METHODS: Sixty eight patients ages ranged from four to ten years have spastic neuromuscular involvement. A 90 degree straight leg hamstring lengthening performed in a specified manner. The mean length of follow up was 7 years 3 months (range 2years 4months -13years). RESULTS: Fifty-one of the sixty-eight patients had at least one level improvement in their Gross Motor Function Classification score. The popliteal angle and straight leg raising improved postoperatively measured at the most recent follow up (p<0.0005).Non of our patients had regression of the popliteal angle to the preoperative level. Nineteen patients (27.9%) had a mean recurvatum of 6 degrees. With the most recent follow up only eleven (16.1%) patients persisted with recurvatum at stance and gait. CONCLUSION: The 90 degrees straight hamstring lengthening may be considered a safe, simple and effective procedure with comparable or lesser complication rate.

Keywords

cerebral --- palsy --- hamstring --- crouch


Article
Study of Lipid Profile in Patients with Uterine Fibroid

Authors: Lilyan W. Sersam
Pages: 274-279
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Abstract

ABSTRACT: BACKGROUND: Leiomyomas are the most common gynaecological neoplasms. Despite the major public health impact of leiomyomas, little is known about their cause. As fibroids are hormone-dependent tumours and their development can be promoted by estrogens, an inverse association between hypercholesterolemia and fibroids should be observed as well as direct association between high-density lipoprotein cholesterol (HDL-C) levels and the presence of fibroids. OBJECTIVE: To investigate the lipid profile in patients with uterine fibroids and to compare it with the lipid profile of women without fibroids. METHODS: A case-control study was conducted in the Department of Obstetrics and Gynaecology at Al-Yarmouk Teaching Hospital during the period from May 2008 to May 2009. Participants were one-hundred twenty pre-menopausal women aged between 18 and 45 years who were recruited during their visit to the gynaecological outpatient clinic and were not taking hormonal therapy. Cases consisted of 60 women with uterine fibroids, and controls were 60 women visiting the same gynaecological outpatient clinic for routine reasons. Thorough history and examination was done for each participant. Body Mass Index (BMI) was measured in kg/m2. All patients underwent a baseline ultrasound examination and classified into two groups according to the presence or absence of uterine fibroids. All women where scheduled to undergo blood test at the beginning (2nd -5th day) of their next menstrual cycle. Fasting venous blood glucose and lipid profile were determined in blood samples taken for each patient. Atherogenic index was also calculated. RESULTS: Women with uterine fibroids were found to have significantly higher levels of serum HDL-C compared to the controls (P=0.0001). A significantly lower levels of total serum cholesterol, low-density lipoprotein cholesterol (LDL-C) were also found in women with uterine fibroids compared to the controls (P=0.0001). Atherogenic index was significantly lower in fibroid group compared with controls (P=0.0001). There was a significant positive correlation between largest fibroid volume and HDL-C level (P<0.0001). CONCLUSION: Women with uterine fibroid have lower atherogenic index compared to women without uterine fibroid. Larger volume of fibroid is associated with higher level of HDL-C.


Article
Association Between Testicular Microlithiasis and Infertility

Authors: Waleed Nassar Jaffal
Pages: 280-283
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Abstract

ABSTRACT: BACKGROUND: Testicular microlithiasis (TM) is an uncommon condition, usually brought to attention when some other condition is being investigated. There have been reports suggesting a link between testicular microlithiasis and testicular dysfunction and tumors. OBJECTIVE: To study the association between testicular microlithiasis and male infertility. MATERIALS AND METHODS: From January 2010 to January 2011, 140 patients with different scrotal lesions presented to urologic consultation department at Al-Ramadi teaching hospital were included in this prospective study, all patients were examined by gray scale and doppler ultrasonograghy, their age ranges from 15 to 55 years. All cases of microlithiasis were recorded and complete information obtained from each patient. Seminal fluid analysis (SFA) was done for each patient with microlithiasis. RESULTS: The age of patients ranges from 15 to 55 years (mean 34.6). Of 140 patients, 6 patients had microlithiasis (4.28%). Of 6 patients with microlithiasis, 5 patients were married and infertile and one of them had varicocele and one patient had testicular atrophy. One patient was unmarried but has varicocele and abnormal seminal fluid analysis. CONCLUSION: There is strong association between testicular microlithiasis and infertility. Hypospermatogenesis in patients with TM may relate to both the degree of testicular dysgenesis and the presence or absence of concomitant scrotal pathology (eg, scrotal varicocele and testicular atrophy


Article
Histopathological Effect of Lactobacilli on Murine Spleen

Authors: Abed Hassan Baraaj
Pages: 284-288
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ABSTRACT: BACKGROUND: Lactobacilli are ubiquitous in the environment and in human body. They widely used as probiotic therapeutic agents. However, several authors reported that this bacteria may cause several serious infections in various parts of human body. OBJECTIVE: This work is aimed to illustrate the histopathological effect of lactobacilli in murine spleen which play a major role in the immune system. MATERIALS AND METHODS: Three Lactobacillus isolates (namely, L. bulgaricus, L. plantarum and L. acidophilus) were isolated form yogurt, vinegar and vagina, respectively. These isolates were injected intraperitoneally in mice in a dose 1.5 X 108 CFU/ml. RESULTS: Several histopathological changes were caused by lactobacilli represented by degeneration, necrosis, presence of haemosidrin and macrophages and lymphoblasts. CONCLUSION: This non-pathogenic bacteria was able to cause severe damage to the spleen of mice.

Keywords

lactobacilli --- spleen --- red pulp --- white pulp


Article
Gallbladder Carcinoid Tumor in a 68 Years Old Patient

Authors: Ali Jabir Al- Kafaji
Pages: 289-291
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ABSTRACT: BACKGROUND: Gallbladder carcinoid tumor is a very rare neoplasm, usually lacking specific symptoms. In most instances, gallbladder carcinoid tumors are incidentally found after a cholecystectomy for other gallbladder disorders or on postmortem autopsies. CASE PRESENTATION: We are presenting a case of a 68 years old male patient with a carcinoid tumor of the gall bladder with liver involvement. Patient presented with signs and symptoms of acute cholecystitis. Conservative treatment was done. Investigations were done for the patient and surgery was performed as elective open cholecystectomy 6 weeks later. Multiple liver nodules were found during surgery ,biopsy material was taken from these nodules and send for histopathology in addition to the removed gall bladder. CONCLUSION: Avery rare condition of Gallbladder carcinoid tumor with liver metastasis.

Keywords

Table of content: volume:11 issue:2