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Article
Renin – angiotensin system (RAS) and hypertensive disease"From the link in pathophysiology to the outcomes of inhibition"

Author: Aasem M. AL-Chalabi عاصم الجلبي
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2009 Volume: 35 Issue: 1 Pages: 73-86
Publisher: Mosul University جامعة الموصل

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Abstract

SUMMARY
The renin – angiotensin system is a major contributor to both hypertension and associated pathophysiologic changes in the heart and cardiovascular wall (The target organ). Major basic and clinical trials have shown that ACE inhibitor and ARB are the main renin- angiotensin system blockers in use assist in controlling hypertension and reducing target organ damage, thus they should be used as a first-line treatment for hypertension. Moreover, ARBs specifically reduces the frequency of atrial fibrillation and stroke, thus it has emerged as a new preventive and therapeutic strategy for these conditions.
In theory, combining ACE inhibitor and ARBs maximizes benefits because it offers more complete RAS blockage but this expectation was not confirmed by most recent clinical trials and was not translated into real patients benefits. Renin inhibition was introduced as a better step for reducing angiotensin II, because it offer complete blockage of the whole system. Early studies confirmed that renin inhibitors reduced blood pressure better than ACE inhibitors but further large clinical trials have been started and therefore in the near future, further clinical evidences will be available to confirm the antihypertensive, anti-inflammatory and antiatherosclerotic effects of renin inhibitor.
List of abbreviations: RAS (renin – angiotensin system), ACE (angiotensin converting enzyme), ARB (angiotensin receptor blocker), AT1 (angiotensin II receptor type 1), AT2 (angiotensin II receptor type 2), AT4 (angiotensin II receptor type 4), LVH (Left ventricular hypertrophy), AF (atrial fibrillation), CCF (Congestive heart failure).

الخلاصة نظام الرنين انجيوتنسين هو عامل رئيس لكل من فرط ضغط الدم والتغيرات المرضية في القلب وجدار الأوعية الدموية (العضو المستهدف). لقد بينت الكثير من الأبحاث الأساسية والسريرية ان موانع أنزيمات محولات الانجيوتنسين ومحصر مستقبلات الانجيوتنسين هما أهم موانع نظام الرنين انجيوتنسين المستعملة حاليا تساعد للسيطرة على فرط ضغط الدم وتقليل تلف العضو المستهدف وعليه يجب استعمالهما كخط أول لعلاج فرط ضغط الدم. اضافة الى ذلك فان محصر مستقبلات الانجيوتنسين خاصة تقلل تكرار حدوث ارتجاف الأذينين والسكتة الدماغية وعليه فقد برزت كطريقة وقائية وعلاجية جديدة لهذه الأمراض. نظرياً، الجمع بين موانع أنزيمات محولات الانجيوتنسين ومحصر مستقبلات الانجيوتنسين يزيد الفائدة لأنها تعمل على منع النظام منعاً تاماً، ولكن هذا التوقع لم يؤكد بأكثر الأبحاث السريرية حداثة ولم ينعكس كفوائد حقيقية للمرضى. موانع الرنين قدمت كخطوة أفضل لتقليل الانجيوتنسين (2) لأنه يعمل على المنع الكلي للنظام بأكمله. الأبحاث الأولية أثبتت ان موانع الرنين خفضت فرط ضغط الدم أفضل من موانع أنزيمات محولات الانجيوتنسين ولكن الأبحاث السريرية الموسعة التي بدأت ستطلعنا في المستقبل القريب عن تأكيد نتائج تأثيرها على فرط ضغط الدم ومضادات الالتهابات وتصلب الأوعية الدموية.

Keywords

RAS --- hypertensive


Article
Malignant gestational trophoblastic disease: a review of seventeen cases

Authors: Haifa Z. Beker هيفاء --- Aasem M. AL-Chalabi عاصم الجلبي --- Yosra T. Jarjees يسرى طاهر جرجيس
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2006 Volume: 32 Issue: 1&2 Pages: 23-28
Publisher: Mosul University جامعة الموصل

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Abstract

Objective: (a) To describe the demographic characteristics of malignant gestational trophoblasic disease (GTD) in Mosul. (b) To evaluate the classification system that stratifies the treatment of the malignant GTD. (c) To know the incidence of malignant changes of mole to malignant GTD.
Design: retrospective clinical case series study done over a period of 5 years.
Setting: Al-Batool Maternity Teaching Hospital and Ibn Seena Teaching Hospital.
Participants: The records of a series of 17 consecutively treated patients who had been diagnosed to have malignant GTD were reviewed. The records of these 17 patients were studied for their age, parity, and mode of presentation. All patients underwent staging studies which included chest x-ray and abdominal ultrasound and were classified as good prognosis group 8 patients (47%) and poor prognosis group 9 patients (53%).
Intervention(s): The good prognosis group was treated with courses of intramuscular methotrexate (50 mg on alternative days 1,3,5,7) with folinic acid rescue (7.5 mg orally on alternative days 2,4,6,8) .The poor prognosis group was treated with methotrexate (10 mg/m2 /day) intravenously (iv), dactinomycin (0.3 mg/m2 /day) iv, and cyclophosphamide (110 mg/m2 /day) iv, for three-day course. Both courses were repeated according to patients’ response.
Results: The mean age incidence of malignant GTD was 37.2 years; the mean parity was 4.6, equally presented from rural and urban areas. The presenting symptom of malignant GTD was vaginal bleeding in 47%, cough and shortness of breath in 41.1%, cough and hemoptysis in11.7%. The blood group was O+ve in 64.7%, A+ve in 17.5%, B+ve in 11.7% and AB+ve in 5.9%. The antecedent pregnancy for malignant GTD was complete mole in 88.2 % (the entire good prognosis group), term pregnancy in 5.9% and abortion in 5.9% (both of them in the poor prognosis group). The mean duration between the antecedent pregnancy and treatment of malignant GTD was 5.7 months. Complete response rate without recurrence was 75% for the good prognosis group and 44.4% for the poor prognosis group. The mortality rate was 0% for the good prognosis group and 33.3% for the poor prognosis group giving an overall cure rate of 58.8%. Hysterectomy was needed in 2 patients (22.2%) of the poor prognosis group. The ratio of changes from complete mole to malignant GTD was about one to nine.
Conclusion: Malignant GTD usually complicated complete mole and presented as poor prognosis type in nearly half of the patients. Classification into good and poor prognosis groups is a successful way for treatment selection.

Key words: Gestational trophoblastic disease, hydatidiform mole, neoplasm staging.


Article
Fine needle aspiration biopsy "FNAB" for peripheral lung lesions: diagnostic value, complications and role of US guidance.

Authors: Talal AL-Saegh طلال الصائغ --- Hazim K. AL-Allaf حازم العلاف --- Aasem M. AL-Chalabi عاصم الجلبي
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2007 Volume: 33 Issue: 1&2 Pages: 9-14
Publisher: Mosul University جامعة الموصل

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Abstract

Objective: To assess the role of ultrasound in guiding fine needle aspiration lung biopsy in peripheral lung lesions.
Methods: Using real-time ultrasonography, Seimense Sonoline equipment with 3.5 and 5.0 MHz transducer, the patients were examined to localize the lesions and prepare for performing biopsy.
Main result: One hundred fifty patients having peripheral lung lesions, 119 (79.3%) males and 31 (20.7%) females with mean age of (56) years were exposed to lung biopsy. One hundred forty (140) patients showed malignant lesions. Six patients had tuberculosis, two patients had interstitial pneumonitis and other two were normal.
Conclusion: Ultrasound guided transthoracic biopsy appears very safe and effective method for the diagnosis of peripheral lung lesions when bronchoscopy failed to reach the lesion, and to avoid the need of thoracotomy to achieve that.

الهدف: دراسة أهمية فحص الموجات فوق الصوتية في الإرشاد والتوجيه لأخذ خزعة من الرئة في حالات الإصابة بالعلل الطرفية الموقع.الطريقة: تم فحص هؤلاء المرضى بجهاز الموجات فوق الصوتية نوع سيمنس واستخدام مسبار قوته (3.5 و5) ميكا هرتز لتحديد موقع العلل في الرئة وتوجيه إبرة الخزعة لأخذ نسيج منها.النتائج الرئيسية: تم فحص مائة وخمسين مريضا مصابين بعلل في الرئة طرفية الموقع, منهم (119) ذكوراً (79%) و (31) إناثاً (20%) تتراوح أعمارهم بين 45-74 سنة وبمعدل 56 سنة . وتم اخذ خزعة نسيجية من تلك الأورام , وبعد تحليلها نسيجيا تبين أن (140) مريضا منهم مصابون بأورام سرطانية خبيثة , و (6) مرضى مصابون بداء التدرن الرئوي ومريضان مصابان بالتهاب رئوي , ولم يتم تشخيص أية حالة مرضية في مريضين اثنين .الاستنتاج: إن اخذ الخزعة من الرئة بمساعدة جهاز الموجات فوق الصوتية اثبت نجاحاً وهو فحص امين في تشخيص العلل في الطرفية الموقع في الرئة وخاصة بعد فشل فحص ناظور القصبات في الوصول لتلك العلل ، ويقلل من إجراء عمليات فتح الصدر لأخذ تلك العينات أو الخزعات.

Keywords

FNAB --- US guidance

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