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: 2008 volume:7 issue:2

Article
Iraqi Children with Acute Bacterial Meningitis... Who May Need Ventilatory Support?

Authors: Muhi Kadhem Al-Janabi
Pages: 100-105
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ABSTRACT: BACKGROUND: Acute bacterial meningitis (ABM) is one of the most potentially serious infections occurring in infants and older children. Indications for PICU admission are shock, markedly elevated intracranial pressure (ICP), coma, and refractory seizures (1). METHODS: This cross sectional study enrolled children 2 months-12 years of age presented with (ABM) who were admitted to Children Welfare Teaching Hospital (CWTH) -Medical City- Baghdad, including those who needed Pediatric Intensive Care Units (PICUs) admission in CWTH Unit and Surgical Specialty Hospital (SSH) Unit in the period from the 1st of Feb 2004 to the 1st of Feb 2006. The diagnostic inclusion criteria of (ABM) were clinical symptoms and signs of meningitis plus a CSF neutrophilic pleocytosis with a CSF cells count of more than 5 cells/mm3 (1). Data included history, clinical examination, investigations, complications, PICU management, and outcome. Statistical analysis was done by using SPSS version 13.0 computer facility, Chi-square test and T test were used when needed and a P.value < 0.05 was considered significant. RESULTS: In the present study (ABM) in children 2 months -12 years constituted 7% of cases admitted to PICUs. The majority of cases (77.2%) were below 2 years of age. The mean age of children with (ABM) was 18.3+6.80 months. The PICU cases of (ABM) differed from the neurological ward cases in their more acute onset, higher body temperature, higher peripheral WBCC, lower CSF glucose, and higher CSF cell count, higher CSF protein, lower serum calcium and longer duration of stay and all these characteristics showed highly significant differences The case fatality rate of children with (ABM) is 13.3%. CONCLUSION: The study concluded the need for PICU admission in children with (ABM) with acute onset, higher body temperature, higher peripheral WBCC, lower CSF glucose, and higher CSF cell count, higher CSF protein, lower serum calcium, and recommended laboratory and PICU service expansion


Article
Ear, Nose and Throat (E.N.T) Diseases in Children: Patterns and Risk Factors.

Authors: Mahmood Dhahir Al-Mendalawi
Pages: 106-111
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ABSTRACT: BACKGROUND: Ear, nose, and throat (E.N.T) diseases are common in children. Early diagnosis and proper management are essential to ensure adequate growth and development. OBJECTIVE: To determine patterns of E.N.T diseases in children and define risk factors affecting them. METHODS: A Cross- sectional study of 264 children under the age of 12 years attended E.N.T clinic/ Al-Kindy Teaching Hospital/ Baghdad from the period of 1/10/2006 to 28/2/2007. We analyzed the following data: age, gender, residence, family size, socio-economic status, parental educational level, family history of atopy, presence of smoking, state of vaccination, presence of anemia or any concomitant chronic illness, and final diagnosis. Statistical analysis was done through Chi-Square. RESULTS: Males outnumbered females (48.1% vs. 51.9%) (P>0.05).The encountered prevalent E.N.T problems included those of pharynx and tonsils (41.7%), nose (18.6%), ear (16.3%), larynx (6.8%), adenoids (6.0%), sinuses (5.3%), and miscellaneous disorders (5.3%). Overall, infections were the predominant (57.9%) followed by foreign bodies impaction (11.7%) and allergy (6.0%). Statistical analysis revealed that crowding, low socio-economic status, poor parental educational level, smoking, and anemia were statistically significant risk factors (P<0.05). CONCLUSION: Pediatricians and E.N.T specialists share a combined responsibility in managing properly the commonest pediatric E.N.T problems. Enhancement of educational and preventive programs targeting the relevant risk factors is suggested.


Article
Activated Peripheral Blood Lymphocyte Subpopulation in Newly Diagnosed Type 1 Diabetes Mellitus Children

Authors: Eman Mahdi Saleh
Pages: 112-120
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SUMMARY: BACKGROUND: In Type 1 Diabetes Mellitus (T1DM), numerous changes in the cellular as well humoral immune response have been identified. However, it is not known whether both the CD4+ and CD8+ subpopulation or only one of these or CD19+contains increased numbers of activated cells. OBJECTIVE: The aim was to study the activated lymphocyte subpopulation by use of monoclonal antibodies to T-cell and B-cell antigens which is known to be expressed on activated cells. METHODS: A total of 60 T1DM patients who had newly onset of the disease (diagnosed was from one week up to five months) were included in the present study, all the patients were treated with daily replacement doses of insulin. Fifty apparently healthy control subjects underwent the PBL phenotyping. Phenotyping of surface antigens was done by direct Immunoflurocent (IFT) technique using mouse antihuman CD3, CD4, CD8, CD45RA, CD19, and activated markers CD45RO, DR-antigen and CD38. RESULTS: T1DM patients showed a remarkable lowering in CD3+, CD8+, and CD45RA+ cells (p<0.0001), but the decrease in CD4+ cells percentage was not significant. In contrast, a significant elevation of activation markers includes (CD45RO+, HLA-DR+ and CD38+ cells) were observed in patients in addition to a significant increase of CD19+ cell percentage and CD4+: CD8+ ratio in the patients. CONCLUSION: This study provides evidence that abnormalities of T-cells regulation are detectable in patients with T1DM.

Keywords

T1DM --- CD markers --- immunophenotyping


Article
Juvenile Delinquency in Iraq : A Psychosocial Profile

Authors: Abdul Rasoul Alyasiri
Pages: 121-128
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ABSTRACT: BACKGROUND: Juvenile delinquency is a sort of crimes that is committed by young persons under the age of 18 years. OBJECTIVE: Is to determine the psychosocial profile of juvenile offenders in Iraq. METHODS: This phenomenon was studied in Iraq from2003 -2005, to acquire a better understanding of it, 400 accused were assessed in the personality assessment bureau [P.A.B] using ICD -10 clinical based interview sorted down with descriptive data. RESULTS: The highest age for the accused was 17 years, predominantly males with a socioeconomic history of deprivation, premature labor, illiteracy, and limited primary education. Their families were living in rather more or less similar conditions. Theft as a crime was on the top of the list. CONCLUSION: According to the [P.A.B], the majorities of the accused were not mentally ill, and before the juvenile court were fully responsible. Half of the sample was recommended to juvenile rehabilitation centers, and about one fifth of the accused were able to be released on legal bailing.


Article
Psychological Burden of a Child with Cerebral Palsy Upon Caregiver in Erbil Governorate.

Authors: Eqbal A.Mu'ala
Pages: 129-134
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ABSTRACT: BACKGROUND: A with disabled child have a great burden on caregiver is, they are under the risk of having depression, anger, and can be under great stress. Caregivers have stroking emotional and behavioural changes such as forgetfulness, depression, dependence, lack of motivation, often felt confined, and fatigue from their responsibilities. OBJECTIVES: To assess the psychological burden of child with Cerebral Palsy (CP) upon his/ her caregivers. METHODOLOGY: A descriptive study was conducted in the Helena Center (HC) in Erbil Governorate for handicapped children from 15th February to 15th March 2005; Data were analyzed by using frequencies, percentages, mean of scores, comparative significant, Pearson's correlation, and multi regression analysis. RESULTS: Of the study indicate that (85%) of caregivers are child's mothers (68%) their age between (25–38) years, (60%) are illiterate, (79%) come from low Socio Economic Status (SES), (46%) live in crowded situations, (50%) of CP at preschool age, (54%) were males, (58%) of CP children diagnosed at infant stage. (80%) of CP is spastic type, (34.4%) of CP children have mutism, and (33.7%) has Mental Retardation (MR) accompanying CP. CONCLUSION: There is a highly significant association between the psychological burden and the age of caregiver, crowding index, complications like mutism, MR and epilepsy.


Article
Phagocytic Index in Patients with Visceral Leishmaniasis in Iraq

Authors: Shahlaa Mahdi Salih
Pages: 135-140
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ABSTRACT: BACKGROUND: Visceral Leishmaniasis is an endemic protozoal disease in Iraq. Recovery from this disease confers a solid and permanent immunity. Immunological assessment of our patients was carried out and the results showed that a significant increase in phagocytic index in patients with VL in comparison with control group. AIM OF THE STUDY: Determining phagocytic index. METHODS: Blood samples were collected from 50 patients suffering from VL confirmed parasitologically by bone marrow smears, 40 blood samples from apparently healthy children and 50 blood samples from children in an endemic area (Al-Suwaira district).Their age was less than six years in all groups, and who were apparently healthy. RESULTS: The immunological assessment of our patients was carried out and the result showed that a significant increase in phagocytic index in patients with Visceral Leishmaniasis in comparison with control group (p<0.01). While the result of endemic control group by ELISA, IFAT and IC were used to test 50 serum samples from healthy children who lived in an endemic area. A total of 48 cases of them were found to be negative at least by one of the above tests, IC showed the lowest cross reactivity rate (4%). CONCLUSION: Phagocytic index was higher in patients with Visceral Leishmaniasis in comparison with control group.


Article
Sandpaper Dermabrasion for Treatment of Acne Scars and Amateur Tattoos in Dark Skinned Individuals

Authors: Ali Waleed Al-Aadamy
Pages: 141-146
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ABSTRACT: BACKGROUND: Dermabrasion is an abrasive process used to remove the epidermis and superficial dermis to treat a variety of skin conditions. OBJECTIVE: To evaluate sandpaper as a tool for dermabrasion for the treatment of acne scar and amateur tattoo. PATIENTS AND METHODS: This is an open labeled therapeutic trial. It was conducted at the outpatient department of Dermatology and Venereology - Baghdad Teaching Hospital, during the period between January 2003 and December 2004. Ten patients (seven males and 3 females) were enrolled in this work. Their ages ranged from 20-34 years with the a mean ± SD of 26.80 ± 4.34 years. Five with acne scars on their faces and 5 with amateur tattoos in the upper extremities.. From each patient history was taken and physical examination was performed. Pre-operative medications and instructions were given to each patient. The procedure was done under local anesthesia. Postoperatively all patients were instructed to use steroid-antibiotic ointment and hydroquinon-tretinoin thereafter. Follow up was done after 1weak, 1month, and 3 months. Repeated sessions may be needed 1 month apart. Acne scars: Lesions were assessed for correction of contour (unchanged, partially changed, or completely changed), and for complications that might follow. Amateur tattoos: Lesions were assessed for percentage of pigments removal (70%, 80%, 90%, and 100%), and for complications that might follow. RESULTS: Ten patients completed the study. Acne scar group: Three patients achieved partial change of contour after 2 sessions, while complete change of contour was noticed in 2 patients after 4, and 6 sessions respectively. The procedure resulted in very fine, less noticeable scar with smooth contour of the skin which was acceptable in all patients. Amateur tattoos group: Complete removal of pigments was achieved in one patient, more than 90% in 3 patients, and more than 80% in 1 patient. No significant complications were seen apart from mild erythema and mild infection in one patient with amateur tattoo. Temporary post inflammatory hypopigmentation in two patients with tattoo. Three patients had mild scar after removal of tattoo. CONCLUSION: Sandpaper dermabrasion is an effective mode of treatment for acne scar and amateur tattoo. It is safe in dark skinned people.

Keywords

dermabrasion --- acne scars --- tattoo


Article
The Role of Plasma Lipoprotein and Carotid Doppler in Detecting Premature Atherosclerosis Among Iraqi Patients with Systemic Lupus Erythematosus

Authors: Khudhir Zghayer Mayouf Al-Bidri
Pages: 147-151
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ABSTRACT: BACKGROUND: Cardio vascular involvement is fatal and critical complication of the systemic lupus erythematosus. Serum lipid profile and carotid Doppler studies can be used to evaluate premature atherosclerosis among patients with systemic lupus erythematosus . OBJECTIVE: The purpose of this study was to detect premature atherosclerosis among Iraqi patients with systemic lupus erythematosus by estimation of fasting serum lipid profiles and Doppler Carotid studies. PATIENTS AND METHODS: Fifty Iraqi patients (45 females and 5 males) who fulfilled the American College of Rheumatology (ACR) 1997 revised criteria for classification of SLE were studied . Another 50 healthy (45 females and 5 males) individuals matched for age and sex were collected from relatives and accompanying persons with patients attending the Rheumatology Clinic and studied serving a control group. Full history was taken and complete clinical examination was done for all patients and control group .The levels of serum cholesterol , low and high density lipoprotein and triglycerides were estimated and Doppler studies for common carotid arteries were done for individuals in both groups. The patients were classified according to clinical presentation to four groups: Group 1: Patients with mucocutaneous and musculoskeletal manifestation only. Group 2 : Patients with mucocutanous,musculoskeletal manifestation and serositis. Group 3: Patients with mucocutanous, musculoskeletal, serositis and lupus nephritis without cerebritis. Group 4: Patients with Mucocutanous , musculoskeletal, serositis and lupus cerebritis without nephritis. RESULTS: There were no significant differences in total cholesterol level in group 1 patients compared to control group, but there were significant differences in group 2,3,4 patients compared to control group.There were significant differences in cholesterol, low density lipoproteins (LDL),high density lipoproteins (HDL),and triglyceride (TG) levels between SLE patients compared to control group which is positively correlated with disease duration .There were no significant differences in intimal media thickness(IMT)in group1and2 compared to control group but there were significant differences in IMT in group 3 and 4 compared to control group and the significant differences in IMT were positively correlated with disease duration. CONCLUSION: The results showed that SLE patients mostly have hyperlipidemia as well as ultrasonic markers of atherosclerosis.


Article
Malnutrition and Growth Status in Patients with Congenital Heart Diseae

Authors: Rabab Hasan Baaker
Pages: 152-156
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ABSTRACT: BACKGRAUND: Different congenital heart diseases could affect children growth. AIM OF STUDY: To assess the growth (Weight, height and head circumference) in patients with different types of congenital heart disease (CHD). METHODS: The growth of one hundred ninety six patients with CHD, attending the out patient department of the Central Teaching Hospital of Pediatrics and Ibn Al Betaar Center for Cardiac Surgery, aged 0-24 months, between February and June 2002 was assessed. They were grouped according to cardiac diagnosis: Group I: Acyanotic CHD without heart failure (HF) or pulmonary hypertension(PH); Group II: Acyanotic CHD with HF; Group III: Acyanotic CHD with PH; Group IV: cyanotic CHD. RESULTS: It was found that 29.6 % of patients with CHD had acute malnutrition (AM) and 21.9% had chronic malnutrition (CM). The acute malnutrition was more in group I of CHD (39.2%) while chronic malnutrition was more in group III of CHD (26.3%). The acute malnutrition was more obvious in infants (31.7%) than in those in the second year, while chronic malnutrition was more obvious in second year of life (34.7%). CONCLUSION AND RECOMMENDATIONS: In all patients with congenital heart disease( cyanotic and a cyanotic),the growth is affected. Because of the delay in surgical correction in our patients, so we suggest a better nutritional counseling and possible earlier surgical correction to optimize the growth in our patients.


Article
Evaluation of the Posterior Interosseous Artery Flap in Reconstructing Hand Defects

Authors: Osam Ahmed Ibraheem
Pages: 157-163
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ABSTRACT: BACKGROUND: The posterior interosseous artery flap is now increasingly considered as an alternative to the radial and ulnar forearm flap because the later required disruption of major arterial supply of the hand. OBJECTIVE: To evaluate the posterior interosseous artery faciocutaneous flap in reconstruction of hand defects as regard to durability, color match and donor site morbidity. METHODS: During a period of 21 months, 10 patients with age ranging between 22-54 years underwent reconstruction of hand defects by distally based posterior interosseous artery flap in Al-Wasity Teaching Hospital. RESULT: All the flaps survived completely. One case developed partial graft failure due to early mobilization. Two cases developed temporary weakness of extensor muscles of the hand due to neuropraxia of the posterior interosseous nerve. The over all result is good functionally and acceptable aesthetically. CONCLUSION: Posterior interosseous flap is a good option in well selected patients and meticulous planning and delicate dissection as well as adequate immobilization minimize the complications like nerve injury, edema and graft loss.


Article
A Study on the Relationship between Thyroid Hormones and Adenosine Deaminase Enzyme Activity in Patients with Auto- Immune Hyperthyroid Disease

Authors: Ahsan Khlil Abbas
Pages: 164-167
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ABSTRACT : BACKGROUND : Adenosine deaminase ADA catalyzes the deamination of adenosine in purine metabolism . Adenosine deaminase deficiency is an inborn error resulting in immunodeficiency condition . clinical interest in this enzyme has been revived by the discovery of a syndrome of severe humoral and cellular immunodeficiency associated with deficiency of ADA in somatic erythrocyte cell . AIM OF STUDY: The aim of present study is conducted to find the relationship between human hyperthyroid activities and immune etiology in graves disease. MATERIALS AND METHODS : Forty individuals with hyperthyroidism autoimmune state were included in this study in comparison with forty normal persons . Thyroid hormones levels were estimated by HPLC and serum ADA specific activity was estimated using spctrophotometric method at 265 nm . Serum protein value was determined by Bradford method . RESULTS : Serum ADA activity was measured for 40 hyperthyroid patients as well as 40 normal individuals . The mean activity of ADA in patients was higher than in the controls . A significant increase in T3 / T4 ratio and level of TSH were noticed . CONCLUSION : A positive correlation between thyroid level and ADA enzyme activity was noticed .


Article
The Value of Second Look Transurethral Resection in the Evaluation and Management of Patients with Bladder Tumors

Authors: Tariq Aziz shahatha Khemees
Pages: 168-173
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ABSTRACT: BACKGROUND: The role of a routine second transurethral resection in evaluating and management of patients with bladder tumor is defined. PATIENTS AND METHOD: From January 2004 to October 2006, 100 patients with new or recurrent bladder tumors underwent repeat transurethral resection within 4-6 weeks after the initial resection, and the results, including the presence of residual tumor and tumor stage, were compared. RESULTS: Of 100 cases, 28 (28%) had no tumor and 72(72%) had residual tumor on repeat TUR. Out of 64 cases with superficial (Ta, Tis, T1) bladder tumors, 20(31%) had residual non-invasive tumor and 13 (20%) were upstaged to muscle invasive tumor. Among 36 patients with a muscle invasive tumor, 10(28%) had no residual tumor on re-TURBT. Results of second resection had changed treatment option in 39 patients (39%) from the initial treatment recommendation which was given after the first TUR. CONCLUSION: many patients with bladder tumor have residual tumor present after an initial TUR. Routine repeat resection is advised to control noninvasive tumors and to detect residual tumor invasion.


Article
Schistosoma – Associated Bladder Cancer in Iraq Single Center Pathologic Review

Authors: Ausama Saadi Abdul Muhsin
Pages: 174-177
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ABSTRACT: OBJECTIVE: To study the frequency of schistosomiasis in pathologic urinary bladder specimens and the contribution of transitional cell and squamous cell types to the schistosoma – associated and non schistosoma – associated bladder cancer among Iraqi patients. METHODS: This is a retrospective study in which 1092 pathologic records of 933 patients, who underwent urinary bladder biopsies from bladder tumors or suspicious lesions discovered incidentally during endoscopic evaluation and those who ultimately had radical cystectomy and urinary diversion for invasive bladder cancer, were reviewed in Surgical Specialties Hospital, Baghdad, Iraq between June 2000 and June 2007. RESULTS: In this study 933 patients aged 2-100 years with a mean age of 56.87±14.3 years. Pathologic review showed schistosomiasis in 81 (8.68%) patients of whom schistosoma associated bladder cancer was reported in 49 (60.5%) patients and schistosomiasis with no pathologic evidence of malignancy in 32 (39.5%) patients. The cell type of schistosoma associated bladder cancer was transitional cell carcinoma (TCC) in 26 (53%), squamous cell carcinoma (SCC) in 19 (38.7%), adenocarcinoma in 1 (2%), and undifferentiated in 3 (6.12%) patients. Out of 852 patients with no pathologic evidence of schistosomiasis, 563 were reported to have non schistosoma associated bladder cancer. The cancer cell type was TCC in 491 (87.21%), SCC in 45 (7.99%), adenocarcinoma in 15 (2.66%), undifferentiated in 11 (1.95%) and sarcoma in 1 (0.18%) patients. CONCLUSION: Schistosoma associated bladder cancer is still a problem in Iraq as well as other endemic countries. Although the major histological cell type of such cancer in Iraq was SCC, there is a trend for increasing frequency of TCC among patients infected with schistosomiasis.


Article
Isolation of tRNA From Uropathogenic Escherichia Coli

Authors: Ibtesam Ghadban Auda Al-Grawi
Pages: 178-181
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ABSTRACT: BACKGROUND: Transfer RNA is a type of RNA which during protein synthesis Act as an adaptor molecule ,matching amino acids to their codons on mRNA . tRNA also functions in the formation of cross links during peptidoglycan synthesis. AIM OF THE STUDY: The aim of this study is that, extraction of tRNA from uropathogenic Escherichia coli then detect the presence of such molecules after extraction and measure the purity of the tRNA extract solutions. METHODS: Thirty uropathogenic E.coli isolates were isolated from hospitalized and non hospitalized patients, complaining of urinary tract infections, of Al-Kadhymia Teaching Hospital and subjected to tRNA extraction. A method of tRNA extraction was modified by adding sodium dodecyl sulfate (SDS)instead of urea. Polyacrylamide gel electrophoresis and two methods of staining ,ethidium bromide staining and silver staining ,as well as spectrophotometric detection were used. RESULTS: Ethidium bromide stained gel reveals bands with molecular weight less than yeast rRNA .Silver stained gel shows bands with molecular weight less than ova albumin(45000 dalton ) but with approximate molecular weight of chymotrpsinogen(24000 dalton). CONCLUSION: The tRNA extracts were relatively pure with the modified method of extraction. In the present study, a modification of polyacrylamide gel electrophoresis to detect tRNA and to determine their molecular weigh was applied.


Article
Glycemic Control in A Sample of Iraqi Patients with Type 2 Diabetes in Response to Nateglinide: Preliminary Study.

Authors: Fadhil Al-Douri
Pages: 182-186
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ABSTRACT: BACKGROUND: Nateglinide, structural derivative of the amino acid D-phenylalanine, is a stimulator that controls the meal time spikes to restore of the early phase of insulin secretion lost in type II diabetes. OBJECTIVE: To evaluate the efficacy and tolerability of nateglinide in combination with metformin in a sample of Iraqi type II diabetic individuals,and to look for its side effects. Setting: The Specialized Center of Endocrinology and Diabetes-Baghdad. Design: During the period between September 2001 and January 2002 a sample of ten type II diabetic patients whose glycemic control is poor on metformin glibenclamide combination. Glibenclamide was replaced by nateglinide. Postprandial plasma glucose levels were checked frequently, and glycosylated hemoglobin (HBa1c) was evaluated in the 24th and 32nd week of the study period. RESULTS: It has been found that using nateglinide in a dose of 120 mg before each main meal three times daily does not reduce plasma glucose HBa1c to the desired levels, but using it in a dose of 180 mg before each meal results in gradual satisfactory decrement in plasma glucose and HBa1c. No adverse effects were recorded and metformin - nateglinide combination was well tolerated. CONCLUSION: Nateglinide and metformin improve overall glycemic control. Nateglinide decreases meal time glucose excursions. Their combination has a complementary effect, improving HBa1c and postprandial hyperglycemia. No adverse effects were recorded and metformin - nateglinide combination was well tolerated.


Article
Intestinal Perforation of Pedunculated Hepatocellular Carcinoma CASEREPORT (Rare among rarities)

Authors: Raafat Roof Ahmed
Pages: 187-191
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ABSTRACT: vascular stalk and is easily resected without sacrifice of significant amount of non-neoplastic liver tissue (1). BACKGROUND: Pedunculated type is a rare macroscopical form of hepatocellular carcinoma. THE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL.7, NO. 2, 2008 CASE REPORT: 47 years old male complained from vague abdominal pain, anorexia, weight loss and malena during the last few months. Abdominal ultrasound and spiral CT scan revealed a vascular mass 17x13 cm. in diameter occupying the whole right side of the abdomen. On exploration the mass was perforated into a segment of ileum due to direct invasion and attached to the liver by vascular pedicle. The mass was completely excised with segment of ileum followed by end-end anastomosis. Immunohistochemical study shows that the tumor was stained by alpha-fetoprotein staining confirming the diagnosis of pedunculated hepatocellular carcinoma. This is a case report of pedunculated HCC which perforated into small bowel causing severe bleeding per rectum, to highlight the importance of this rare and potentially curative disease. CASE REPORT : CONCLUSION: pedunculated hepatocellular carcinoma should be kept in mind in any differential diagnosis of large intraperitoneal mass even if it is not related to the liver by imagining study.

Table of content: volume:7 issue:2