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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E-mail:IPMJ2000@yahoo.com

Table of content: 2006 volume:5 issue:2

Article
Drugs Use for Diarrhoea In Children At Home

Authors: Luay Al-Nouri
Pages: 122-127
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ABSTRACT: BACKGROUND : Children's acute diarrhea is an extensive global problem .It has increased in Iraq seventeen fold after wars and economic sanctions. Proper management is important in saving lives and prevention of complications. We wanted to see what drugs were used, how often and how it compared with oral rehydration use. METHOD: The mothers of 175 children who presented with diarrhoea of acute onset and admitted to the Children Welfare Hospital, Baghdad, over a period of 8 months were interviewed. RESULTS: Apart from 39 children, who had parenteral infections, two had celiac disease and one accidentally ingested a laxative, the others were diagnosed as gastroenteritis at hospital. Of the 102 children diagnosed as gastroenteritis before admission, 29(28%) had their stools microscopically examined and a parasite was found in 12. Seventy- three (75%) of those who did not have stools examined, and (59%) of those who had no parasites demonstrated in stool were given antibacterials (metronidazole, gentamicin, amoxycilin, +/- cloxacilin, co-trimoxazole). Many had antiemetics and anti spasmodics. Oral rehydration solution (ORS- WHO) was given to (46%) of patients. CONCLUSION: Seventy-Four (73%) of children with gastroenteritis were given anti bacterials at home and less than half had ORS.

Keywords

Drugs --- Diarrhoea --- Children .


Article
L-1α and IL-8 levels in leukopenic leukemic patients with bacteremia

Authors: Sevan N. A. Abdallah
Pages: 128-131
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ABSTRACT: BACKGROUND: Interleukin-1α and Interleukin-8 are an inflammatory cytokines. They are a heterogeneous group of humeral mediators of the inflammatory response. In leukemic patient's leukopenia developed as a result of cytotoxic chemotherapy and/ or disease itself. Therefore, those patients were suffering from low number of leukocytes in addition to defects in the function of these cells. Normally leukocytes are the main source of cytokines production. METHODS: IL-1α and IL-8 were studied in (84) adult patients, males and females and more than 15 years old. The leukemic patients were suffering from leukopenia and bacteremia. The study including (20) healthy. Interleukin-1α and interleukin-8 concentrations were measured by using a commercially available enzyme-linked immunosorbent assay (ELISA). RESULTS: Statistical analysis shows significant increase in the levels of IL-1α and IL-8 between leukopenic leukemic patients with bacteremia and healthy control group. CONCLUSION: Leukopenic leukemia patients strikingly show distinct increases in plasma IL-1α and IL-8 levels during bacteremia.

Keywords

Bacteremia --- Leukemia.


Article
Clinical Profile and OutComeOf Respiratory Failure In Iraqi Children

Authors: Muhi Al-Janabi
Pages: 132-137
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ABSTRACT: BACKGROUND: The frequency of acute respiratory failure is higher in infants and young children than in adults.Acute respiratory failure remains a significant cause of morbidity and mortality for children . PATIENTS AND METHODS: One hundred and twenty children under the age of 15 years presented with respiratory failure and admitted to RICU in Children Welfare Teaching Hospital and Surgical Specialty Hospital in Medical City - Baghdad in the period from the 1st of May -2003 to the 30th of June 2005 were enrolled in a descriptive study. RESULTS: Seventy nine (65.83%) cases were males and 41 (34.17%) were females. Male / female ratio was 1.93:1.The mean age was 30.21 months, 35 (29.16%) cases were neonates. Sixty eight (56.7%) cases were from urban areas and 52 (43.3%) were from rural areas. Seventy eight (65%) children were admitted for medical diseases and 42 (35%) were admitted for surgical problems. The most common medical causes were respiratory (50%) followed by neurological (37. 17%).The most common respiratory cases were bronchiolitis (28.2%) and most common neurological cases were Guillain- Barre Syndrome (58.6%).The majority (90.47%) of surgical cases were admitted post-operatively. The average duration of stay in RICU was 9.71 days. Fifty three patients (44.17%) survived and 67 (55.83%) died. CONCLUSIONS: The most common age group admitted to RICU is infancy, medical cases are more commonly admitted than surgical cases, the most common medical causes of admission are respiratory followed by neurological causes, the most common respiratory cause of admission is acute bronchiolitis.


Article
Spiral Computed Tomography Findings In Clinically Suspected ACute Pulmonary Embolism

Authors: Nazar B. Elhassani
Pages: 138-145
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ABSTRACT: OBJECTIVES: To show the role of enhanced spiral computed tomography in clinically suspected acute pulmonary embolism(PE) patients . PATIENTS AND METHODS: From October 2003 to October 2004, Fourty two patients with clinically suspected acute pulmonary embolism ,were examined by thin slices contrast enhanced spiral computed tomography as the primary diagnostic test to role out or confirm the diagnosis of pulmonary embolism. Patients were examined in the Radiology Departments of (Al-Kadymia, Al-Yarmook & Ibn Al-Bittar Teaching Hospitals). RESULTS: Pulmonary embolism diagnosed in 43% of the patients by showing clot within pulmonary arteries with or without non specific signs like effusion , wedge infarct & dilated pulmonary artery .CT was normal or gave an alternative diagnosis that could explain the patient’s signs & symptoms in 52%. Inconclusive findings were seen in 5%. CONCLUSION: Computed tomography can be used safely as the primary diagnostic tool in clinically suspected acute pulmonary embolism patients, to confirm or role out the diagnosis.

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Article
The Prevalence of Silent Gall Stones And Its Relation To Some Risk Factors in Iraq

Authors: Safa M. M. AL-Obaidi
Pages: 146-150
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ABSTRACT: BACK GROUND : Gallstone disease is a common condition all over the world as well as in Iraq. Symptomatic gallstones definitely need surgical or medical treatment . To remove or treat silent gallstones is still a debatable subject. Gallstones are about twice as common in women than in men and their incidence vary according to some physical fasters METHODS : 1016 adult volunteers from both sexes and of different age groups were examined by ultrasound in Medical city teaching hospital between January 2004 and August 2005, for the estimation of the prevalence of silent gallstones among Iraqi people and it's relation to some physical and familial factors was studied . RESULTS: The incidence of silent gallstones in both sexes was 3.3%. It is more common in women 4.09% than in men 2.2% and it increases with age, parity, and the use of contraceptive pills, and high intake of black tea The size of most of the stones was less than 20 mm and they were less than three in number, the gall bladder was with a normal wall thickness, no associated mass , or gallbladder wall calcifications, and no association with specific blood group or obesity was found. CONCLUSIONS: Silent gallstones were found in 3.3% of healthy Iraqi individuals, and they are associated with the same risk factors of symptomatic gall stones such as age , parity , familial contraceptive except that obesity and blood groups are not a major risk factor.


Article
Evaluation of Amino acid Homocysteine in Hypertensive Patients

Authors: Ali Taqi. Al-Baldawi
Pages: 151-154
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ABSTRACT : BACKGROUND : Hypertension is a world wide disease and in 90% of cases the cause is unknown . Its early detection and treatment can prevent serious complications such as ischemic heart disease (IHD) . Furthermore the association of lipids with IHD is a well-known fact . However abnormally high levels of homocysteine were found to be strongly linked to an increase risk of coronary artery disease . OBJECTIVES: To evaluate the total plasma homocysteine concentration in hypertensive patients. METHODS : Total plasma homocystein concentrations were measured using High Performance Liquid Chromatography(HPLC) with Ultraviolet( UV) detector in 60 hypertensive patients (27 male and 33 female) aged 35 years and more . Cholesterol , triglyceride , HDL-cholesterol , LDL-cholesterol , VLDL-cholesterol were determined .The prevalence of high total homocysteine values were determined by comparison with normal reference population. RESULTS : Total plasma homocysteine levels were significantly higher in patients than in normal population. Total serum cholesterol and triglyceride concentrations were also significantly higher in patients than in normal population with no association to the level of homocysteine which is regarded as a special independent vascular risk factor. CONCLUSION : The study involves the evaluation of homocysteine in hypertensive patients plasma homocysteine levels were significantly higher in patients than in control groups. There were no significant differences between male and female patients.


Article
Role of Color Doppler Ultra Sound Versus Histopathology in Differentiating Malignant From Benign Breast Masses

Authors: Hassan H. Zaini
Pages: 155-159
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ABSTRACT: BACKGROUND: Cancer of breast is by far one of the most important clinical problems that concerns the surgeon. It is the commonest form of cancer in females, when detected early and given the proper treatment can be cured. Color Doppler imaging is modern technique that can be used in preoperative assessment of breast lumps. OBJECTIVE : To asses the role of color doppler imaging in differentiating malignant from benign breast lumps in comparison with the histopathology in AL- Najaf teaching hospital. METHODS: Total number of patients was 80 female of different age groups were assessed during the period from first of February 2004 to the first of February 2006 , presented with variable palpable breast masses. After clinical assessment, all our patients underwent , color doppler imaging and then subjected to the excisional biopsy and histopathology for confirmation of the diagnosis. RESULTS: The results of color doppler imaging for all our patients were found as follow, benign lumps in 54 cases (67.5%),malignant lumps in 26 cases (32.5%),two cases diagnosed as benign by color doppler imaging proved to be malignant by histopathology giving ( 2.5%),false negative rate. All obtained results of sensitivity, specificity and over all accuracy of color doppler imaging respectively as follow (92.85%),(100%),and(97.5%). CONCLUSION: Color doppler imaging is highly sensitive and specific method in evaluating malignant breast masses and is painless, non-invasive and time saving procedure, so we can reduce the rate of unnecessary surgery for histopathology.


Article
The Pattern Of Indications, Complications Of Splenectomy Personal Experience

Authors: Nooraddin Ismail Allaqolli
Pages: 160-164
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ABSTRACT: BACKGROUND: A prospective study of Splenectomy personal experience,with changing pattern of indications. METHOD: During the study period (Feb, 1990-Jan, 2006), a total of 411 splenectomies performed in erbil governate for different indications. RESULTS: The study included 411 patients, the age rang were 4– 65 years. Out of 411 cases 201 cases were due to trauma (48.9%). CONCLUSION: Trauma of different types remains the most common indication for splenic surgery & complications like gastric or pancreatic fistula is historical complications.

Keywords

Spleenectomy.


Article
Random Abdominal Flaps for Reconstruction of Upper Limb War Injuries: A Good Option for a Bad Time

Authors: Harith Abdul Jabbar Al Ani
Pages: 165-171
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ABSTRACT: BACKGROUND : Soft tissue war injuries of the upper limb are usually extensive and multiple . Plastic surgeons face the challenge of reconstructing these injuries in patients who are multiply injured ,and in a time when facilities for free flap surgery are not available. OBJECTIVE: To demonstrate the efficacy of random abdominal flaps in reconstructing soft tissue defects of the upper limb. METHODS: From May 2003 to September 2005, 55 war injury patients with deep soft tissue loss in the upper limb were managed by random abdominal flaps of different shapes and directions, 13 of them had other soft tissue injuries affecting other areas in the body. The surgeries were done in busy general hospitals during war where time, personnel and facilities are limited. RESULTS: In 53 patients, the flaps had completely survived without complications, 2 flaps developed partial tip necrosis and healed later by secondary intention. Donor areas were covered by split thickness skin grafts in 52 cases, and directly closed in 3 cases. The largest flap dimension was 18 cm length and 15 cm width. The main disadvantages of the flap are donor site scar, bulk of the flap, and the need for a second stage for flap separation. CONCLUSION: Random abdominal flaps are easy, safe, versatile and operative time saving option for coverage of upper limb injuries. It can be designed in any direction to cover different soft tissue defects. These flaps still continue to be an excellent alternative for free tissue transfers during war time.


Article
Post Stroke Shoulder Pain Problem

Authors: Zeki Nooh Hassan
Pages: 172-176
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ABSTRACT: BACKGROUND: Shoulder pain is one of the complications that happened in patient suffered of hemiplagia our aim is to study this problem in hemiplegics patients due to stroke METHODS: 56 patients affected by different types of stroke were enrolled in this study , each patient was examined by neurologist , CT scan then done and referred to a consultant rheumatologist at alkindi hospital for assessment of his shoulder area , the patient then investigated thoroughly for his or her shoulder pain RESULTS AND CONCLUSION : The study showed high correlation between shoulder pain and older age patients, aphasia, cortical sensory defects The study showed that the frozen shoulder is the commonest cause of post stroke shoulder pain

Keywords

shoulder pain --- stroke


Article
Distally Based Fasciocutaneous Flaps In the Management of Soft Tissue War Injuries of the Lower Half of the Leg

Authors: Tariq Abdul Qadir
Pages: 177-190
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ABSTRACT: BACKGROUND : Soft tissue war injuries affecting the lower half of the leg are a major challenge facing plastic surgeons .Distally based fasciocutaneous flaps have an important role in the management of these defects. OBJECTIVE : To demonstrate the role of distally based fasciocutaneous flaps as an alternative to free tissue transfer in the management of lower leg soft tissue defects. METHODS : Thirty seven war injury patients with soft tissue loss in the lower half of the leg were managed by distally based septocutaneous flaps (19 cases),and distally based superficial sural artery flap (18 cases) , donor areas were closed by partial thickness skin grafts in all of the cases. RESULTS : All of the 37 flaps survived and healed uneventfully except in 4 cases in whom partial necrosis of the flap occurred at the tip. Two cases of distally based superficial sural artery island flaps developed venous congestion and edema . CONCLUSION : Distally based fasciocutaneous flaps are an important alternative to microvascular tissue transfer in treating lower leg war injuries. The versatility and arc of rotation of the distally based superficial sural artery flap were better than in distally based septocutaneous flaps.

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Article
The Effect of the Aqueous Extract of Peganum harmala Seeds on the Mammary Glands of Virgin, Pregnant, and Lactating Rats

Authors: Wasan Al- Saidi
Pages: 191-198
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ABSTRACT: BACKGROUND: Penganum harmala is a well known herb that is used by different societies. It is used as a medical herb in treating various diseases and disorders .There was no earlier published work on the effects of the aqueous extract of Peganum harmala . Therefore, we designed this study to investigate the effect of the aqueous extract of Peganum harmala seeds on the mammary gland at the various physiological states (virgin, pregnancy and lactation) making use of the available histological, histochemical, and immunohistochemical means. METHODS: Aqueous extract of Peganum harmala was given for two weeks by an orogastric tube on single regular daily dosage to Norway albino female rats. Animals were subdivided into subgroups according to their physiological states. Mammary glands of these animals were routinely processed for histological, immunohistochemical and histochemical studies using formalin fixative ,paraffin embedded sections in the first two studies and formal calcium, frozen sections in the third study. Experimental specimens were compared with that of control subgroups. RESULTS : Harmal induced mammogenesis in the mammary glands of virgin rats. It's aqueous extract was able to initiate lactogenesis in a well-prepared mammary gland (i. e. during pregnancy) and finally this aqueous extract promotes lactogenesis when administrated during lactation. CONCLUSION : Peganum harmala is a mmammogenic herb . KEYWORDS: Peganum harmala, mammary


Article
Differentiation Between Two Isolates Of Entamoeba histolytica Isolated From Different Clinical cases After Intraceacal Inoculation In Hamsters

Authors: Raja ,a.AL -.Alousi
Pages: 199-203
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ABSTRACT: BACKGROUND: The aim of this study is to differentiate between virulence of two isolates ,one was isolated from severe clinical symptoms of amebiasis isolate (A) the other was from asymptomatic carriers isolate (B). METHODS : 12 male hamsters were employed in this study , they were divided into 3 groups . 1st group (5 hamsters), inoculated intracecally with isolate isolate (A) from human case of severe amebiasis . 2nd group (5 hamsters) inculated with isolate (B) from asymptomatic carriers .3rd group (2 hamsters)inoculated with saline solution as control group . RESULTS : 1st group of hamsters showed a flask shaped ulcer with sever inflammation of cecum with liver abscesses , after four weeks of infection The 2nd group showed only mild inflammation of cecum without ulceration and liver abscess. While 3rd group were normal control group. CONCLUTION: Our study may be Considered as a step for Characterization of Entamoeba histolytica that cause the invasive intestinal and extraintestinal amebiasis and E.dispar an intestinal commensal parasit in Iraq.


Article
Epstein- Barr Virus In Iraqi Patients With Nasopharangeal Carcinoma

Authors: Batool Mutar Mahdi
Pages: 204-208
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ABSTRACT: BACKGROUND: Epstein-Barr virus (EBV) was ubiquitous Herpes virus that had a role in the development of undifferentiated carcinoma of the nasopharynx, Burkett’s lymphoma, acute infectious mononucleosis and other lymphoprolifrative disorders. METHODS: Thirty Iraqi patients with nasopharangeal carcinoma were referred to Oncology Unit in Al-Kadhemia Teaching Hospital from 1992-1994. Sera of those patients were tested for the presence of antibodies against Epstein-Barr virus nuclear and early antigens using indirect immunoflourescence test. Cellular immunity for those patients was tested for the CD4+, CD8+, CD4/CD8 ratio, T-cells % and B -cells %. Their results were compared with twenty-two normal apparently normal individuals. RESULTS: Antibodies to Epstein-Barr virus nuclear and early antigens were detected in nasopharangeal carcinoma Iraqi patients and not in the control group. There was significant difference between two groups in CD8+ cells, T- cells % and B- cells % and there was no significant differences between two groups in CD4+ cells, CD4/CD8 ratio. DISCUSSION: EBV infection was stopped by T- cells immune response that was capable of eliminating virus infected cells and virus neutralizing antibodies against nuclear and early antigens which prevent the spread of infection. Lymphocytes were predominantly CD8+ cytotoxic T lymphocytes, which recognize and destroy EBV infected cells. RECOMMENDATIONS: Other antibodies to viral capsid antigens (IgG, IgA and IgM). Other methods must be used other than indirect immunoflourescense test like western blot method and enzyme linked immune sorbent assay (ELISA).


Article
Evaluation of EBV serum and salivary IgA antibodies level in head and neck cancer patients

Authors: Ahmed Sahib Abdulamir
Pages: 209-212
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ABSTRACT: BACKGROUND: Many previous studies revealed that salivary and serum IgA response to infectious agents such as EBV-coded antigens in patients with nasopharyngeal carcinoma (NPC) had a vital role in the combat against tumorigenesis. Moreover, it could be considered as a reliable index for the humoral limb of anti-cancer immunological action. METHOD: One hundred twenty two head and neck cancer (HNCA) patients were selected randomly from two main hospitals, Alkadhimya hospital and radiotherapy center in Baghdad. Also 100 apparently healthy control subjects (HC) underwent the same examinations and tests. Enzyme-linked immunosorbent assay (ELISA) test was applied on all HNCA patients sera and saliva, in order to measure anti-EBV IgA antibodies . RESULTS: Revealed that NPC patients were the only group that showed a sero-positive ELISA readings of anti- EBV serum IgA. No saliva EBV antibodies were detected in the studied groups . CONCLUSIONS: S.IgA level seems to be an applicable index for evaluating EBV burden originated from nasopharyngeal cancerous cells. Such index might help in diagnosing early and specifically the carcinogenesis of NPC, moreover, might help in evaluating the progress of the disease.


Article
Prevalence of Autoantibodies to Various Tissue Antigens Before and During S2 – Complex Immunotherapy in Head and Neck Cancer Patients

Authors: Batool M. Mahdi
Pages: 213-222
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ABSTRACT : BACKGROUND: A total of 63 terminal untreatable stage IV head and neck cancer patients were investigated for clinical responses and presence of autoantibodies to various tissue antigens before and during S2- complex immunotherapy. METHODS: S2 –complex is a new low molecular weight biological response modifier (BRM) with a potant immunostimulating and anti tumor activities. RESULTS: Autoantibodies detected at pretreatment period were those directed towards the following antigens : nuclear, thyroid microsomal, epithelial cells, gastric parietal cells, smooth muscles, peripheral leukocytes, T-lymphocytes, B-lymphocytes, monocytes, thymus reticular epithelial cells and Hassall’s corpuscles. Beside, autoantibodies with specificities to glomerular basement membrane and vascular endothelial cells were present at low incidence. Short term use of S2- complex induced a transient increase of the following autoantibodies: nuclear, thyroid microsomal, epithelial, parietal cells, smooth muscle, thymus reticuloepithelial cells, Hassal’s corpuscles, thymocytes, peripheral blood leukocytes, T, B-lymphocytes, monocytes, as well as kidney glomerular basement membrane and vasculr endothelial cells. DISCUSSION: In the later follow up period i.e. 2-6 months most of these autoantibodies responses returned to normal healthy control levels. Moreover, two exceptions were demonstrated which were the incidences of the antiglomerular basement membrane and vascular endothelial antibodies which remianed higher than the pretreatment frequencies. In addition, autoantibodies specific to mitochondria , thyroglobulin and red blood cells were only occasionally seen in our head and neck cancer patients both before and during S2- complex therapy.


Article
The Location of Aerobactin Determinants of Uropathogenic E. coli in Association with Hemolysin Production Antibiotic Resistance and Patient Characteristics.

Authors: Ibtesam Ghadban Auda
Pages: 223-229
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ABSTRACT: BACKGROUND: Aerobactin, Hemolysin and the resistance to some antibiotics axe important Features of Uropathogenic E. coli (UPEC). The characteristics of patients from which we isolate the UPEC have associate with these Features and their determinants location. AIM: We determined the phenotypic expression and gene location of Aerobactin and phenotypic expression of Hemolysin among 60 UPEC isolates. We correlated the presence of Aerobactin system with antibacterial agents resistance. The expression of Hemolysin and the characteristics of patients. METHODS: Two methods of plasmid curin, sodium dodecyl sulfate and elevated temperature plasmid curing, are used then plasmid extraction and agarose gel electrophoresis are performed to determine the location of Aerobactin determinants and the size of Aerobactin plasmids, as well as the location of the determinants of some antibiotics resistance which were ampicillin (Am), Tetracycline (Tc), gentamicin (GM), Chloramphenicol (C) and co- trimazole (Co). RESULTS: Aerobactin and hemolysin expression among UPEC isolates were 93.3% and 35% respectively. The isolates of non compromised patients produce statistically higher rate of expressed hemolysin (90.5% , p<0.01). Plasmid- borne Aerobactin was absent in UPEC isolates of non compromised patients (89.5%, p<0.01). On the contrary compromised patient isolates express plasmid Aerobactin of 59.5% (p<0.02). We also found that Aerobactin determinants are located on a plasmid in compromised patient isolates and associated with the absence of chromosomal Hemolysin production (82.9%, p<0.01). Yet, The chromosomal aerobactin is associated with hemolysin production (61.9%, p<0.02). Furthermore, UPEC isolates of compromised patients carry relatively large plasmid of Aerobactin (85.7%. p<0.05) and these large plasmids carry either chloramphenicol (83.3%.p<0.02) or gentamicin determinants (100%. P<0.01) but not co- trimazole, tetracycline or ampicillin. CONCLUSION: The isolates of non compromised patients carry chromosomal Aerobactin and hemolysin. While the isolates of compromised patients express plasmid Aerobactin and do not express chromosomal hemolysin. Aeobactin plasmids are relatively large plasmids and carry either chloramphenicol or gentamicin resistance determinants.


Article
The Laryngeal Mask Airway: technical guidelines and use in special situations

Authors: Ahmed Abdulameer SALIH
Pages: 230-239
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Summary: Recent advances in airway management have changed the practice of anesthesia. Among these changes has been the introduction and increasing use of the Laryngeal Mask Airway (LMA). The laryngeal mask airway (LMA) is a novel device that fills the gap in airway management between tracheal intubation and use of the face mask. This study describes the LMA, different methods of LMA insertion, uses, advantages, problems, complications and contraindications of LMA. During eight years of LMA use in Al-Yarmook teaching hospital in Baghdad, the device was used for wide spectrum of surgical procedures successfully. We report some special series of cases were LMAs were used in providing a patent airway include LMA use with IPPV (intermittent positive pressure ventilation), for patient with history of failed intubation, for children who require general anesthesia for ultrasonic shock wave lithotripsy, the use of reinforce flexible LMA for nasal surgery and the use of total intravenous anaesthesia with LMA. Also we describe two methods of blind endotracheal intubation through LMA.


Article
Adult Ebstein Anomaly with Right Atrial Myxoma

Authors: Hameed Al Ani
Pages: 240-245
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ABSTRACT: BACKGROUND: Ebstein Anomaly is rare in adults; a combination of this disease with cardiac myxoma has not been reported previously. METHODS: Surgery was performed by removal of the myxoma and replacement of the tricuspid valve and correction of the abnormal atrialization of the right ventricle. RESULTS: The patient had a smooth postoperative recovery and improved dramatically after wards. CONCLUSION: We have dealt with this rare condition successfully and the patient had good outcome.

Table of content: volume:5 issue:2