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: 2014 volume:13 issue:3

Article
Association of Vitamin D Metabolite Levels with Relapse Rate and Disability in Multiple Sclerosis

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ABSTRACT: BACKGROUND: Multiple sclerosis is an inflammatory demyelinating disease of the central system. It estimated to affect more than 2・5 million people worldwide. It is the most common non-traumatic cause of disability in young adults. Although the cause of multiple sclerosis remains undetermined, number of risk factors for MS have been identified and they can loosely be put into one of two categories; genetic or environmental components. Epidemiologic studies have suggested there is an increase in incidence and prevalence of MS with increasing latitude north and south of the equator. Latitude has implicate vitamin D status as a determinant of risk. OBJECTIVE: To study the association of vitamin D level with relapse rate and disability in patients with relapsing remitting multiple sclerosis in Iraq. PATIENTS AND METHODS: Thirty patients (6 males and 24 females) with relapsing remission multiple sclerosis (RRMS), their age range from 16 to 45 years, recruited from MS clinic of neurology department of Baghdad teaching hospital in the medical city in Baghdad and twenty five completely healthy controls (6 males and 19 females) from general population and their age range from 20 to 40 years were enrolled in this study in the period from April 2011 to the end January 2012. RESULTS: The present study shows low vitamin D levels for both patient with RRMS and control group. There is significantly lower 25(OH)D level in patients with relapse compared with patients without relapse in the last 6 weeks. Also we found higher expanded disability status scale (EDSS) in patients with relapse compared with patients without relapse in the last 6 weeks. Lastly, we didn’t find any correlation between vitamin D level and EDSS in patients group study. CONCLUSION: We concluded from this study that there is low circulating level of 25(OH)D in RRMS patients, especially during relapses. Also there is no effect of vit D on disability


Article
The Impact of Long Term Prognosis of Troponine in High Risk Unstable Angina

Authors: Haitham Noaman Al-Koubaisy
Pages: 306-309
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ABSTRACT: BACKGROUND : To evaluate the long term prognosis (6 months of follow up) regarding mortality , acute myocardial infarction and coronary angiography results in patients with troponin positive or negative in high risk unstable angina pectoris . METHODS : All patients included in this study were adults, 73 patients, 52(71.24%) male versus 21(28.76%) female of different ages . All had clinical features of ischemic chest pain of high risk unstable angina. They attended private clinic in HIT city, Anbar Governorate ( West of Iraq ) during the period January 2010 – December 2012. All had planner ST-segment depression in electrocardiography (ECG) according to concordant ECG leads other ECG findings of T- wave inversion or ST- elevation myocardial infarction were excluded, measurement of serum troponin test was done for all patients. All patients included in the study were admitted to coronary care unit (CCU) and received full treatment including heparin and discharged from hospital when they were clinically stable. Coronary angiography was done for all patients and followed up for 6 months. RESULTS : From all patients included in this study 27(36.98 % ) were troponin positive unstable angina, 3 (11.12%) patients of them were died and 24 (88.88 % ) patients of them survived. Their coronary angiography were sever type in 11(40.74 %) patients and they did coronary artery bypass surgery(CABG) and 13(48.14 % ) patients had multiple lesions in more than one vessels and need more than one balloon and stent(Percutaneous trans luminal coronary angioplasty PTCA) .While those whom troponin negative unstable angina were 46( 63.02 %) patients all were survived, only 5 (10.86 %) of them need coronary artery bypass surgery, 27 (58.69 %) patients need single or multiple stents , 4(11.5 %) patients had non critical coronary artery lesion only for medical treatment and the remaining 11 ( 41.81 %) patients were had normal coronary angiography . CONCLUSION : Troponin positive high risk unstable angina carry poor prognosis where has 3 times more mortality risk and more likely to be in need for surgery and difficult stenting and may not be able to be treated surgically or by stenting but medically without intervention than negative troponin high risk unstable angina .


Article
Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction in Ibn Alnafees Hospital, Baghdad

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ABSTRACT: BACKGROUD: Primary percutaneous coronary intervention (PCI) provides outcomes superior to fibrinolytic therapy in acute myocardial infarction (AMI), but no registry or study in Iraq has demonstrated its use in hospital. OBJECTIVE: To evaluate using of primary PCI for acute MI in Ibn Alnafees hospital –Baghdad. METHODS: Patients between 2010 and march 2013 having symptom onset within 12 hours and either ST-segment elevation of - 1 mm in - 2 contiguous leads or presumed new left bundle branch block (LBBB) in electrocardiogram (ECG) who were treated with primary PCI were included in this study. Two patient had cardiogenic shock treated within 16 hours. RESULTS: A total of 76 patient included in this study having primary PCI for acute MI. successful result reported in 71 of cases, while death reported in 2 cases, slow flow in 2 cases, no re flow in one case and stent thrombus formation in one case. No need for urgent or elective CABG. CONCLUSION: Primary PCI for patients with AMI having ST-elevation or new LBBB is a safe and effective strategy


Article
Outcome of Induction Therapy in Adult Patients with Acute Myeloid Leukemia

Authors: Alaadin Sahham Naji
Pages: 313-319
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ABSTRACT: BACKGROUND: Treatment of patients with newly diagnosed acute myeloid leukemia (AML) has improved during the past decades due to the intensification of induction and post remission chemotherapies and due to the incorporation of autologous and allogeneic transplantation procedures. Untreated acute leukemia is a uniformly fatal disease with a median survival time shorter than 3 months. OBJECTIVE: To evaluate the outcome of induction and complications post induction in adult patients with Acute Myeloid Leukemia(AML) in Baghdad Teaching Hospital PATIENTS AND METHODS: A total of 47 patients diagnosed as de novo AML who had been admitted within twelve months from January till December 2012 in hematology unit of Baghdad Teaching Hospital were included. Treatment of the 47 eligible patients for remission induction with standard intensive treatment course consisted of the combination with standard-dose cytosine arabinoside 100 mg/m2/d continuous infusion on days 1-7, with of doxorubicin in a dose of 30mg/m2 over half an hour infusion on day 1-3.Response to therapy was assessed for complete remission or persistence of leukemic cell post induction. Pattern and severity of infections and their relationship with granulocytopenia. were analyzed. RESULTS: The patients had a mean age of of 36.7 years ranged from 14 to 72 years. Performance status in 15 patients was 0 or I while the majority (43) patients was with PS of II-IV at diagnosis according to WHO/ECOG performance status scale. Duration between symptoms of AML prior diagnosis till suspicion of a diagnosis of AML at a referring hospital and confirmation of the diagnosis at our institute have been assessed with( mean +SD) duration 32±22.1days. of the 47 patients 22(47%) achieved complete remission post first induction (CR1)and further 5(11%) patients have CR2(after second remission) and 20(42%) was refractory to treatment. Focus of infection during marrow hypoplasia have been identified in 26(59%) patients. CONCLUSION: Based on the current data ,the remission rate was nearly comparable to the results with other reports . Intensification of anthracyclins and identification of cytogenetic and other independent prognostic relevance are needed to obtain better results.


Article
Dyslipidemia in Young Adults Aged (20-40) Years Attending Baghdad Teaching Hospital and Al-Mansour Primary Health Care Center in Baghdad City

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ABSTRACT: BACKGROUND: Hyperlipidemia is a condition characterized by high quantities of lipids in the blood stream. Lipids include cholesterol, triglycerides and phospholipids. Fats and cholesterol are generally processed in the liver and carried on proteins in the blood, forming lipoproteins. Its complications include pancreatitis, atherosclerosis, coronary artery diseases and stroke. OBJECTIVE: Is to estimate the prevalence of hyperlipidemia in the Iraqi young adults aged 20-40 years and to shed a light on any significant association between some socio-demographic and life style variables with hyperlipidemia. SUBJECTS & METHODS : A cross-sectional study was conducted from the first of December 2011 to the first of June 2012. RESULTS : The prevalence rate of any lipid abnormality (at least one abnormality) was 75%.The prevalence rates of elevated serum total cholesterol, low serum high density lipoprotein cholesterol, elevated serum triglyceride and elevated serum low density lipoprotein cholesterol were (32.5%, 38.5%, 29.5%, 30%), respectively. The prevalence rate of elevated TC/HDL ratio was 61%. CONCLUSION : There is a high prevalence of lipid abnormality in young adults of whom males had higher prevalence than females but the difference was not significant.The significant associated risk factors with hyperlipidemia were age, BMI, newly diagnosed or uncontrolled diabetic and hypertensive patients, cholesterol/fat rich diet and type of cooking oil.


Article
Evaluation of the ‘Ovarian Crescent Sign’ in the Preoperative Determination of the Nature of Adnexal Masses

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ABSTRACT: BACKGROUND: There are no universally accepted criteria for distinguishing between benign and malignant ovarian masses on the basis of ultrasound findings. Risk of malignancy indices have been proposed, but these methods use complex calculations and study multiple parameters to develop a score. The detection of normal ovarian tissue in the adnexal masses, the ovarian crescent sign, is highlighted as a single ultrasound parameter prejudging the nature of adnexal mass as benign or malignant. It has been reported that absence of the “ovarian crescent sign” is a more sensitive indicator of malignant nature than the risk of malignancy indices. OBJECTIVE: To evaluate whether the presence of normal ovarian tissue adjacent to adnexal masses (the ‘ovarian crescent sign’) could assist in the preoperative differential diagnosis of these masses, and to compare its accuracy with standard biochemical and sonographic indices. METHODS: Sixty four women with adnexal masses were included in this prospective observational study. Serum cancer antigen 125 levels were measured and transvaginal and/or transabdominal ultrasound scans of the adnexae were performed and the tissue adjacent to the mass was examined for the presence of the ‘ovarian crescent sign’. The risk of malignancy index was calculated and all the findings were compared with the final histopathological diagnosis and the accuracy of each test was compared to the others in the form of sensitivity, specificity, positive and negative predictive values. RESULTS: Fifty five out of sixty four women were found to have benign masses, one had a borderline tumor and eight had invasive malignant lesions. Normal ovarian tissue ‘ovarian crescent sign’ was seen in fifty three out of fifty five women with benign lesions but it was not seen in any one of the nine women with malignant lesions. In the absence of the “ovarian crescent sign”, ovarian cancer was diagnosed with a sensitivity of 100% and a specificity of 96.4%. For the cancer antigen 125 test, the sensitivity was found to be 77.7%, specificity 92.7%; for the Risk of Malignancy Index, sensitivity was 55.6% and specificity was 89.1%. CONCLUSION: The “ovarian crescent” sign is a reliable sonomorphological feature that can help to exclude ovarian cancer in patients with adnexal masses, while its absence highly indicates malignancy.


Article
Role of Nucleated Red Blood Cells in Umbilical Cord Blood as A Marker of Neonatal Asphyxia with Meconium Stained Amniotic Fluid

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ABSTRACT: BACKGROUND: Neonatal asphyxia is a major cause of neurologic morbidity and mortality. Recent studies suggest increased nucleated red blood cells in neonates with meconium aspiration syndrome, supporting that the pregnancy with meconium stained amniotic fluid is at high risk of fetal hypoxia. OBJECTIVE: To evaluate the role of umbilical cord nucleated red blood cells as a marker of neonatal asphyxia with meconium stained amniotic fluid. PATIENTS AND METHODS: This study was conducted at the Department of Obstetrics and Gynecology and Nursery Department in AL- Kadhymia Teaching Hospital from April 2010 through April 2011as prospective case controlled study. The study included one hundred pregnant women, who were admitted to the delivery ward, they were arranged into two groups. Group one included fifty women with meconium stained amniotic fluid, considered as study group and the other group included fifty women with clear amniotic fluid, considered as control group. This for determination of umbilical cord nucleated red blood cells and comparison between two groups. RESULTS: The percentage of abnormal nucleated red blood cells count (NRBCs) in the study group (30%) was significantly more than the control group (18%) (P value =0.002).The mean nucleated red blood cells count (NRBCs) difference was 3.69 units and it was significantly higher in the study group than the control group (P value =0.0002). CONCLUSION: The nucleated red blood cells (NRBCs) count increase in cord blood of neonates with meconium stained amniotic fluid compared to neonates of clear amniotic fluid.


Article
The Effect of Metformin on Serum Lipids in Overweight and Obese Patients with Polycystic Ovary Syndrome

Authors: Asma Zuhair Fadhil --- Foud AL-Dahhan
Pages: 342-347
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ABSTRACT: BACKGROUND: Polycystic ovary syndrome is a very common condition affecting 4% to 18% of women. Polycystic ovary syndrome is associated with metabolic features and diabetes and cardiovascular disease. OBJECTIVE: To evaluate the effect of metformin on serum lipids in overweight and obese women with polycystic ovary syndrome. METHODS: An observational prospective study conducted at AL- Diwanyia Maternity and child Hospital from May 2011 to March 2013. All women in this study have BMI >27 (range) so, they are all overweight and obese .The women randomized into two group; one group were recieved metformin therapy for 4 months duration and the other group were kept on no therapy and followed for the same period. All studied women were subjected to measurement of fasting Blood sugar, and measurement of overnight fasting lipid profile which include total cholesterol, triglycerides, high density lipoprotein cholesterol and low density lipoprotein cholesterol. RESULTS: For women who received metformin, there was significant increase in the level of high density lipoprotein P = 0.04. The value of triglyceride although decreased after metformin treatment, the difference was not significant P > 0.05. Other parameters (cholesterol, low density lipoprotein cholesterol) showed no difference. Fasting blood sugar was not changed during the study. CONCLUSION: Metformin have been shown to improve the lipid profiles leading to increase the high density lipoprotein cholesterol, the main predictive of cardiovascular disease in the women with polycystic ovary syndrome.


Article
Laparoscopic Deroofing of Symptomatic Renal Cysts in Al-Jumhoori Teaching Hospital Mosul City

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ABSTRACT: BACKGROUND: Laparoscopy offers a safe and efficacious means of ablating symptomatic simple renal cysts with the benefits of shorter hospital stay, quicker convalescence, and reduced postoperative pain. We evaluated the safety and efficacy of laparoscopic cyst deroofing during our early experience in laparoscopic urology work. OBJECTIVE: To present the outcome of laparoscopic management of symptomatic simple renal cysts in Mosul Urologic Center. METHODS: Between April 2010 and September 2013, 16 patients (had 19 cysts), with male to female ratio of 1:1.6, were underwent laparoscopic deroofing of symptomatic simple renal cysts at urologic theatre in Al-Jumhoori Teaching Hospital in Mosul and their data were collected and analyzed. All procedures were carried out by transperit- oneal approach. Patients underwent clinical review and radiological follow up with ultrasonography ± computerized tomography. Success rate was defined as no recurrence of the cyst and ignificant pain relief. RESULTS: All 16 procedures were completed laparoscopically, without major complic- ations or conversion to open surgery. Estimated mean blood loss during and after surgery was about 119.6 ml and the mean operating time was 48.8 minutes. Patients were hospitalized for a mean of 1.4 days. Five patients developed postoperative fever, and one had incomplete clearance of all cysts. After a mean radiological and clinical follow up of 12 and 23 months respectively, one patient had symptomatic and one had radiologic failure (6.25% and 5.3% respectively). Cytological and pathological findings for malignancy or any other abnormalities were negative in all patients. CONCLUSION: Laparoscopic transperitoneal deroofing of simple renal cysts represents an effective and safe method of treatment with minimal morbidity.


Article
Transanal Endorectal Swenson Pullthrough :Single Center Experience

Authors: Ahmed Aboud. Khalaf
Pages: 356-364
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ABSTRACT: BACKGROUND: Hirschsprung’s disease (HD) is a common cause of intestinal obstruction in children. Definitive treatments consist of excision of the aganglionic segment and anastomosing the normal colon to the anal remnant by trans anal swenson approach. OBJECTIVE: The purpose of this study was to evaluate the feasibility and safety of TESPT technique for management of HD & its results. PATIENTS AND METHODS: It is aprospctive study ,where 33children (30 boys and 3 girls) with proven HD were treated at our pediatric surgical department between April 2009 and November 2013. Their ages ranged from 6 months to 8 years. The case files were evaluated for age at operation, associated congenital anomalies, operative time, intraoperative blood loss and blood transfusion, time to resume oral feeding, hospital stay, postoperative complications, and postoperative continence state. The median follow-up period was 12 months(range 3 to 21 months) . The diagnosis was confirmed by barium enema &/or by partial thickness rectal biopsy for histopathological examination for all cases. Most patients had a well-defined transition zone at or distal to midsigmoid colon on preoperative contrast enema RESULTS: Male to female ratio was 10:1. one patient had positive family history for Hirschsprung's disease . The definitive TESPT was done in the patients at a median age of 10 months( range 6 months - 8 years). Seven patients had primary pull-through without colostomy.The median operative time was 120minutes (range 90-150 minutes). The length of the resected bowel varied between 20cm and 42cm. The length of hospital stay was 3 to 5 days. The time to resume oral feeding was ranging from 24-48 hours. There are 4 patients with recurrence of obstructive symptoms (retained piece) . 3 patients(9.09%) required readmission for treatment of enterocolitis. Postoperative adhesive intestinal obstruction occurred in 1patient (3.03%). Soiling occurred in 3 patient out of 33pts.(9.09%). Perianal excoriation occurring in 7 patients(21.21%) ,1 patient(3.03%) was died. CONCLUSION: Tespt technique is both feasible and safe technique in properly selected children with rectosigmoid HD in all ages. The technique is easily learned and is associated with excellent clinical results.


Article
Prevention of Postcircumcision Meatal Stenosis

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ABSTRACT: BACKGROUND: Meatal stenosis is a condition that almost always is acquired after neonatal circumcision. Circumcision is one of the most common surgical operations throughout the world, and meatal stenosis is one its late complications. We evaluated the topical use of a lubricant jelly after circumcision in boys in order to reduce the risk of meatal stenosis. OBJECTIVE: To evaluate the use of lubricant in prevention of postcircumcision meatal stenosis and other complications. MATERIALS AND METHODS: From April 2010 to September 2012, 300 boys younger than 2 year old referred to AL-RAMADI TEACHING HOSPITAL IN ANBAR,IRAQ and my clinic, were involved in a randomized controlled trial. They were referred for circumcision. The parents in the study group were instructed to use petroleum jelly on the circumcision site after each diaper change for 6 months. In the control group, no topical medication was used. The children were followed up regularly and evaluated for meatal stenosis, bleeding, infection, and recovery time. RESULTS: Three hundred boys younger than 2 years old participated in the study. None of the children in the lubricant group developed meatal stenosis, while 91 (60.6%) in the control group developed postcircumcision meatal stenosis (P 0 .0000) which is statistically highly significant. Infection of the circumcision site was observed in 2 (1.3%) and 14 (9.3%) children of the lubricant and control groups, respectively (P 0 .0004) which is statistically highly significant . Two boys (1.3%) in the lubricant group and 29 (19.3%) in the control group had postcircumcision bleeding (P 0 .0007) which is statistically highly significant. Finally, the mean time of recovery in the lubricant group was 3.8 ± 1.2 days, while it was 6.9 ± 4.2 days in the control group (P = 0.03). CONCLUSION: Based on the findings of this study we can conclude that using petroleum jelly after circumcision is considerably effective for reducing postcircumcision meatal stenosis and other complications.


Article
Clinical Presentations and Management of Thyroglossal Duct Cyst and Sinuses

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ABSTRACT: BACKGROUND: The thyroglossal duct cyst results from a failure in obliterating the embryonic duct produced during thyroid migration and it represents the most common type of developmental cyst encountered in the neck region. Ectopic thyroid tissue neoplasia is rare, and it is even rarer when associated with the thyroglossal duct cyst. OBJECTIVE: To study the clinical behavior, distribution and treatment of thyroglossal cyst and fistula. MATERIALS AND METHODS: A prospective study carried out during the period 2002-2011, in the otolaryngology departments of Al Diwaniyah Teaching Hospital and Gazi Hariri Hospital, 72 patients suffering from thyroglossal cyst and sinuses were diagnosed and treated (60 cysts and 12 sinuses). The data were collected on the basis of history, physical examination, investigations, management and follow up. RESULTS: A seventy two patients complaining from thyroglossal duct cyst and sinuses were diagnosed and treated. 45 male (62.5%) and 27 female (37.5%). The commonest age of presentation is the second decade, 33 patients (46%). The most common clinical presentation of thyroglossal duct cyst is a midline neck mass and a midline anterior neck discharging opening in cases of thyroglossal sinuses. The thyrohyoid region is the most common location of both thyroglossal cysts and sinuses. The histological diagnosis in all the cases was benign (100%). All the patients were managed by Sistrunk s operation. The recurrence was seen in only one patient (1.3%). The incidence of carcinoma in the cysts or sinuses was 0.0%. CONCLUSION : Thyroglossal cysts and sinuses are quite prevalent. Thyroglossal cyst usually appears as a midline swelling in the prehyoid region of the neck. The etiology of thyroglossal sinuses in this study is mostly iatrogenic which means more awareness is required about diagnosis and proper management of thyroglossal cyst. The standard surgical approach is Sistrunk operation for both thyroglossal cyst and sinuses with low recurrence rate.


Article
Surgical Management of Dorsal Wrist Ganglions: A Comparative Study Between Two Surgical Modalities

Authors: Ali Adwal Ali
Pages: 375-378
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ABSTRACT: BACKGROUND: Ganglions are the most common benign cystic swellings found around the wrist, they can be treated conservatively or by different surgical techniques. Our surgical modality (excision of ganglion complex with fat graft) has given encouraging results. OBJECTIVE: To compare the efficacy of excising dorsal wrist ganglions and fat graft and excision alone . PATIENTS AND METHODS: A prospective study was conducted on patients with dorsal wrist ganglions. Surgical procedure in 25 cases was excision of the cysts and its neck , while for the rest 25 cases, excision of the cysts followed by fat graft, then an immobilization for 7-10 days.12-18 months period of follow-up was adopted for detection any recurrence. RESULTS: Most of the patients were females. Most of the patients presented mainly because of cosmetic reasons. Recurrence was the most frequent complication encountered and involved 16 % in those of group A and only 4% in those of group B. CONCLUSION: The technique of excision of dorsal wrist ganglions and fat graft is simple and effective.


Article
Incidence and Causes of Conversion from Laparoscopic to Open Cholecystectomy

Authors: Raed Jawad Witwit --- Aws Khidir Jassim
Pages: 379-383
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ABSTRACT: BACKGROUND: Conversion from laparoscopic cholecystectomy to open procedure should not be considered as a failure; in fact it is an option which should be considered under certain circumstances. OBJECTIVE: Calculation of the conversion rate from laparoscopic to open cholecystectomy and identify its direct causes and some of its risk factors. PATIENTS AND METHODS: Prospective study conducted in Baghdad teaching hospital and nursing home hospital in medical city complex for two years period. Patients with symptomatic gall stones were included in the study and prepared for laparoscopic cholecystectomy all cases were operated upon as elective cases. RESULTS: Two hundred and twenty one (221) patients were enrolled in the study, 177 female and 44 males with female to male ratio 4:1. The mean age of the patients was 38 year .six patients required conversion to open cholecystectomy with all over conversion rate 2.7%. In males the conversion rate was 4.5% and in female it was 2.2%. CONCLUSION: Conversion rate in our study is within the lower limits and accepted internationally. Dens fibrous adhesion is the main cause of conversion. History of acute cholecystitis is independent risk factor for conversion from laparoscopic to open procedure. Gender, age and history of jaundice or ERCP are not independent risk factor for conversion


Article
Value of Fine Needle Aspiration Cytology Under Ultra-Sound Guided Biopsy in the Diagnosis of Prostatic Cancer

Authors: Usama S.Al-Nasiri --- Adil H Hamoodi --- Raghib J Hameed
Pages: 384-389
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ABSTRACT: BACKGROUND: The detection of carcinoma of prostate (CaP )by trans rectal ultrasound (TRUS) depends on the feature produced by the new growth , which leads to changes in the glandular —stromal architecture, appears as Changes in the echogenicity of the prostatic lesion. The fine needle can be guided to the area of suspicion and cytology is done. OBJECTIVE: This prospective study was conducted to demonstrate the usefulness of the fine needle aspiration cytology (FNAC) under transrectal ultrasound (TRUS) guidance in detection of carcinoma of the prostate (CaP). METHOD AND PATIENTS: Fifty male patients aged between (46 - 86) years, were chosen selectively, all with voiding symptoms & suspicion of CaP from an elevated prostate specific antigen (PSA) above the level of 4 ngml in all patients. Thirty patients had abnormal finding on digital rectal examination (DRE), thirty three patients had TRUS abnormal findings. This procedure was carried out in out – patient basis. The cytological results were compared with the tissue diagnoses obtained by surgical interventions. RESULTS: The cytological results revealed 24 case of malignancy & benign in the rest 26 case (23 case of BPH & 3cases of prostatitis).Malignancy was correctly diagnosed by using cytology in 24 out of 28 case confirmed by histopathology as CaP. One case was considered initially as false positive, the cytological result consistent with adenocarcinoma but the histopathology failed to prove it. The statistical analysis revealed that the sensitivity, specificity and accuracy were 85%. 100% & 92% respectively. CONCLUSION: We conclude that FNAC under TRUS guide can be considered as an initial safe cost effective & reliable method for diagnosing of Prostate cancer.

Keywords

KEY WORD: prostate --- FNA --- TRUS --- PSA --- cytology.


Article
Antibiotic Treatment in Patients with Chronic Low Back Pain and Vertebral Bone Edema (Modic Type I Changes): A Randomized Clinical Controlled Trial of Efficacy

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ABSTRACT: BACKGROUND: Modic type I changes/bone edema in the vertebrae are present in 6 % of the general population and 35–40 % of the low back pain population. It is strongly associated with low back pain. Chronic Low back pain (CLBP) is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations.A new method of treatment included the use of antibiotic in management of CLBP with Modic type I changes has proved to be effective in some cases. OBJECTIVE: The aim was to test the efficacy of antibiotic treatment in patients with chronic low back pain (>6 months) and Modic type I changes (bone edema). PATIENTS AND METHODS: The study was a randomized clinical trial(RCT) with 71 patients whose only known illness was chronic LBP of greater than 6 months duration occurring after a previous disc herniation and who also had bone edema demonstrated as Modic type I changes in the vertebrae adjacent to the previous herniation. Patients were randomized to either 100 days of antibiotic treatment or placebo and were evaluated at baseline, and end of treatment. Outcome measures: are the disease-specific disability Questionnaire, which is Roland Morris Disability Questionnaire (RMDQ) and lumbar pain. RESULTS: 43 of the 71 original patients were evaluated at baseline and at end of treatment follow-up. The two groups were similar at baseline. The antibiotic group had better improvement on the outcome measures and improvement continued after end of treatment. At baseline, 100 days follow-up the means of the disease specific disability-RMDQ changed: antibiotic 15.5, 12; placebo: 15, 14.8. For Lumbar pain: antibiotics 6.4, 4.8; placebo 6.1, 6.0. CONCLUSION: The antibiotic protocol in this study was more effective for this group of patients (CLBP associated with Modic changes type I) than placebo in the outcomes.


Article
Anatomical Cervical Cage Versus Autologous Bone Graft for Anterior Cervical Discectomy and Interbody Fusion In Patients with Cervical Disc Degeneration

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ABSTRACT: BACKGROUND: Anterior cervical discectomy and interbody fusion (ACDF) is a surgical technique used to treat a variety of cervical spine disorders, such as nerve root or spinal cord compression, cervical spondylosis, and cervical spinal stenosis (1,2). OBJECTIVE: To evaluate the clinical outcome of ACDF with an autologous iliac crest graft (AICG) versus ACDF with an artificial anatomical cervical cage made of polyethereterketone (PEEK) filled with artificial bone substitute for patients with cervical spondylosis. METHODS: This was a nonrandomized prospective study of 68 patients ( 28 females,41.2%), and (40 males,58.8%) with mean age of 59.4 years, who had symptomatic cervical disc degeneration (CCD) and underwent ACDF from 1st February 2010 till 1st of September 2013. We divided the patients into two groups, group A made of 25 patients underwent ACDF by using AICG and group B made of 43 patients underwent ACDF by using anatomical cervical cage (PEEK) filled with bone substitute. All patients were evaluated preoperatively and six months postoperatively by using Neck disability index (NDI), and Visual analogue scale (VAS) for radicular pain, neck pain and headache. RESULTS : For group A, the postoperative improvement in NDI was statistically significant, and for VAS the postoperative improvement was statistically significant for radicular pain, neck pain and headache. For group B, the postoperative improvement in NDI was statistically significant, and for VAS the postoperative improvement was statistically significant for radicular pain, neck pain and headache. The difference in postoperative improvement between group A and B was statistically not significant for NDI, and VAS (radicular pain, neck pain and headache). CONCLUSION: Both methods are effective in treating cervical spondylosis in selected patients. No method is statistically superior to another in 6 months postoperative clinical outcomes by using NDI and VAS for radicular pain, neck pain and headache.


Article
The Treatment of Flexion Contracture of the Knee Joint in Hemophilic Patients Using Gradual Manipulation and Serial Casting

Authors: Ali Bakir Al-Hilli
Pages: 407-412
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ABSTRACT: BACKGROUND : Hemophilia is a bleeding disorder caused by deficiency of clotting factor VIII or IX; it is inherited as sex linked recessive pattern. Musculoskeletal complications in haemophilic patients are disabling. Bleeding in to the large joints and soft tissues are associated with arthritic changes in the joints and contractures in the soft tissues. Deformities of the large joints especially flexion contractures are commonly seen in knee joint. It is important to prevent deformities, treat existing contractures and prevent recurrence to improve the patient's quality of life. OBJECTIVE: This is a retrospective study analyzing the effectiveness of gradual manipulation and serial casting for treatment of knee joint flexion contracture in Hemophilic Iraqi patients. PATIENTS AND METHOD: We included ten Hemophilic patients type A, treated between 2006-2008, six with unilateral and four with bilateral knee joint flexion contractures, excluding patients with multiple joint contractures other than knees, have severe arthritic changes, have subluxated unstable knees or have acute bleeding. Their age is between 16-22 years, the duration of deformity is 4-9 months, knee flexion contractures between 20-80 degrees and all of them don’t have significant pain but their daily life is severely restricted by the deformity. Under factor cover, general anaesthesia and haematological care, we started serial manipulations and plaster of Paris casting, the number of casts is between 2-6 casts, till we get straight knees. After that splints are prescribed for the patient and followed up for a minimum 6 months, physiotherapy to strengthen the muscles around knee is initiated from the start and gradually increasing after the application of the removable splints. RESULTS: We have ten patients with fourteen deformed knees, after manipulations and serial casting 8 knees get full correction, and 6 knees still have less than 10 degrees of flexion which is acceptable for the patients, all the patients have improvement of their quality of life and walk free of pain after 2 months. CONCLUSION: Serial manipulation and casting under general anaesthesia is a very good maneuver to correct knee joint flexion contractures in hemophilic patients.


Article
Topical Steroid Misuse on the Face: A Medical and Social Problem in Iraq

Authors: Ammar Faisal Hameed
Pages: 413-417
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ABSTRACT: BACKGROUND: The use of topical steroids on the face should be carefully selected by the dermatologist, however its misuse still occur producing dermatological problem resembling rosacea. OBJECTIVE: To highlight the clinical aspects of misusing topical corticosteroid on the face and to search for the causes behind this medical and social problem. METHODS: In this prospective study, 110 Iraqi patients with steroid rosacea or perioral dermatitis with history of topical steroid use on their faces for at least 1-3 months were evaluated at Department of Dermatology -Baghdad Teaching Hospital between January 2011 to December 2013. RESULTS: Majority of patients were young, poorly-educated women who used a combinations of potent and very potent topical steroid for average period of 0.25-12 years. Facial erythema (92.7%) and hotness (89%), dryness (62.7%), telangiectasia (53.6%) and rebound phenomenon (86.3%) with or without papulopustular eruption were the main clinical complaints. Searching for beauty and facial fairness in 51(46%) of patients, hyperpigmentory problems like melisma in 40(36%) patients were the main indications for steroid misuse on the face mostly accomplished through recommendations from non-medical personnel. CONCLUSION: Topical steroid should not be used on the face unless it is under strict dermatological supervision and the easy access to topical steroid preparations must be controlled by the health penalties.


Article
Pre-Emptive Analgesia for Reduction of Postoperative Pain

Authors: Ali Abdul Hammed --- Khulood Salih Al-Ani
Pages: 418-423
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Abstract

ABSTRACT: BACKGROUND: Pre-emptive analgesia is important for reduction of post operating pain in all surgical procedure including inguinal herniorraphy under, general anaesthesia. OBJECTIVE: To compare the effectiveness of pre-emptive analgesia for reduction of post-operative pain in inguinal herniorrhaphy under general anaesthesia. PATIENT AND METHOD: 30 adult ASA1 male patients undergoing inguinal herniorraphy under general anaesthesia were included in randomized prospective clinical study. The patients classified into two groups. Group 1 (n=15) control group receive 20 mg Ketamin Hcl at induction of anesthesia before operation. Group 2(n=15) receive 75 mg diclofenac sodium 30 min.I.M before induction and1 microgram/Kg Fentanyl citrate at induction of anesthesia. Then 20 ml of 0.25% Bupivacaine infiltrated in tissue under abdominal sheath at surgical area after induction of general anesthesia with another 20 ml of 0.25% Bupivacain was deposited in subfascial area after skin incision and. VAS (visual analog scale) score were all recorded. RESULT: In control group (group1) showed mark increase in stress response to post-operative pain as evidence by high visual analogue scale and in stress response to pain as increase in heart rate and mean arterial pressure during 1st 24hr post-operative. While group II patient (study group) mark decrease in post-operative pain as evidence by low VAS and insignificant change in heart rate and mean arterial blood pressure. It shows that pre-emptive analgesia reduces severity of post-operative pain and analgesic requirement in post-operative period. CONCLUSION: Our result indicates that pre-emptive analgesia is effective in reduction of post-operative period.


Article
Immunohistochemical Expression of Her2/Neu Receptor in Human Colorectal Carcinoma (A Clinicopathological Study)

Authors: Kifah Hamdan AbdulGhafour
Pages: 424-429
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Abstract

ABSTRACT: BACKGROUND: Colorectal adenocarcinoma is the most common type of gastrointestinal cancers in Iraq, and according to the Iraqi cancer registry (ICR) reports, the incidence of colorectal carcinoma was 2.99% of whole body malignancies (ICR 2010). In males, it’s the 5th common cancer while in females it’s the 4th most common cancer. Her2/neu is an important oncogene in breast cancer, but its prevalence and significance in colorectal carcinoma have been documented. OBJECTIVE: To determine the frequency and the pattern of Her2/neu expression in colorectal adenocarcinoma by immunohistochemical technique and to correlate this expression with different clinicopathological parameters. MATERIAL AND METHOD: Twenty five cases of colorectal adenocarcinoma were studied, these cases were diagnosed in private laboratories in Baghdad/Iraq from November 2011 to march 2013. Clinicopathological parameters such as age, gender, pathological diagnosis, including the tumor site, size, lymph nodes status, grade and stage of tumor were taken from patients file. Sections of 4 µm stained by H&E stain and immunohistochemical stained for Her2/neu. Using infiltrative ductal carcinoma of the breast as control positive, evaluation of Her2/neu expression by immunohistochemistry in all cases was performed. RESULTS: Fourteen (56%) of the cases were males, 11 (44%) case were females, with age distribution ranging from (24-89) years, with a mean age of 56.5 years. Tumor size ranges between 2.5-10 cm, with mean of 6.25 cm. Seven (28%) cases were localized in the cecum, 5 (20%) from each rectum, sigmoid and left colon, respectively and 3 (12%) involving more than one segment of the colon. Histologically the tumor grade ranges from moderately differentiated in 23 (92%) cases and poorly differentiated in 2 (8%) cases. Regarding pathological staging (TNM system), 5 (20%) were stage T2, 17 (68%) were stage T3 and 3 (12%) were T4. Lymph node involvement found in 10(40%) of the cases and distant metastasis was found in 2 (12%) cases. Her2/neu expression was present in 4(16%) cases of 25 colorectal adenocarcinoma; there was no correlation with age, sex, histopathological grade, location, lymph nodes status and tumor invasion. CONCLUSION: Concerning data exists about the prevalence of her2/new expression in colorectal adenocarcinoma, there was no significant correlation between her2/neu over expression and tumor size, grade, localization of the primary tumor, lymph nodes status and depth of invasion.


Article
Immunophenotyping of Bone Marrow Biopsies in 26 Patients with Non-Hodgkin's Lymphoma, Using Anti-CD3, CD8, CD19 and CD20 Monoclonal Antibodies

Authors: Faris. H. Jaafer --- Raad Jaber Musa M
Pages: 430-433
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Abstract

ABSTRACT: BACKGROUND: Immunophenotyping with monoclonal antibodies (MoAbs) directed against lymphoid-associated antigens, immunohistochemical staining on paraffin-embedded BM biopsy material, and molecular studies of Ig genes/T-cell receptor genes or lymphoma-associated gene translocations should be used in the global approach to the patient with malignant lymphoma. OBJECTIVE: 1. To determine the subtypes of non-Hodgkin lymphomas (B- or T cell) in the bone marrow using anti-CD3, CD8 monoclonal antibodies for T-cell and anti-CD19 and CD20 for B-cells. 2. Correlation of the subtypes of NHL (B- or T cell) with the morphology and pattern of bone marrow infiltration. PATIENTS, MATERIALS AND METHODS: A retrospective study, done in Al-Kadhymia teaching hospital during the period from 1/10/2010 to1/2/2011.The study consisted 26 adult patients, who were diagnosed as Non-Hodgkin lymphomas by undergoing a BM biopsy. Immunohistochemical staining of the paraffin-embedded sections of BM trephine biopsies was performed in all cases and used standard techniques with monoclonal anti-CD8, CD20 and dual immunofluorscence-labelled CD3, and CD19 antibodies and also all stained with Hematoxylin and Eosin (H&E) for morphologic assessment. RESULTS: The 26 cases of NHL comprised of 14 male (54%) and 12 female patients (46%) . The median age was (57.32) year ranged from 27-85 years. There were 23 cases of B-cell cases (88.5%) and 3 cases of T-cell lineage (11.5%) of all the cases. Among all the B-cell lymphomas, 15 cases showed interstitial infiltration in the bone marrow, while among the T-cell lymphoma two cases showed diffuse infiltration. CONCLUSION: 1. In these 26 cases NHL patients with marrow involvement, B cell phenotype comprised 88% of cases. 2. B-cell NHLs had predominance of interstitial infiltration in bone marrow biopsies in comparison with the T-cell lymphoma, in which diffuse infiltration was predominant. .


Article
The Effect of Aspirin on Histology of Placenta

Authors: Eman Ghanim Sheet Al-Hylli
Pages: 434-441
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ABSTRACT: BACKGROUND : Preeclampsia (PE )is a potentially life-threatening hypertensive disorder affecting_ 2-7% of all pregnancies , It is a leading cause of maternal mortality ,and associated with high perinatal mortality and morbidity, including intrauterine growth restriction (IUGR) and prematurity. A daily low dose of aspirin (60-80 mg /day) may use for prevention and treatment of PE and fetal growth retardation in pregnant women at risk. OBJECTIVE: To assess the influence of aspirin therapy on the histology of placenta from mothers with PE and to correlate the findings with those from pre -eclamptic mothers but not using aspirin during their pregnancy and with placenta from normal Pregnancies . METHODS: This study was carried out on one hundred twenty –pregnant women, thirty five with uncomplicated pregnancy and eighty five mothers with PE , fifty of these hypertensive women on aspirin therapy since first trimester. RESULT: It was found that mothers with pre- eclampsia either take aspirin or not had relatively smaller, irregular placentae. Histological features of vascular insufficiency like thrombosis, cytotrophoblastic cellular proliferation, fibrin plaque formation etc. were present in more or less similar amount in both groups of hypertensive placentae. Babies of such mothers were mostly small for date. CONCLUSION : Despite the little improvement in outcomes of the aspirin treated pregnancy, , histologic evidence of placental pathology persisted in the majority of women with PE. so aspirin therapy is not effective in preventing and treatment PE


Article
Trapped Fourth Ventricle: Case Study and Review of the Literature

Authors: Ali HikmatAzeez
Pages: 442-445
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Abstract

ABSTRACT: BACKGROUND: A trapped fourth ventricle is diagnosed when the fourth ventricle is no longer communicates with the third ventricle and the basal cisterns. The resultant obstruction leads to persistent and progressive dilatation of the fourth ventricle

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Table of content: volume:13 issue:3