Iraqi Postgraduate Medical Journal

BACKGROUND:
The objective of this study is to present the results of transduodenal resection of ampullary &
periampullary carcinoma and compare it with that of by-pass surgery.
METHODS:
Out of (64) patients, (35) were subjected to transduodenal resection and (29) to by-pass procedures
during the period 1972-2003 at the Medical City Hospital and Al-Mustansiria Private Hospital,
Baghdad.
RESULTS:
(39) Patients were males and (25) were females. Age ranged from (19-80) peak (60-69) years.
Fluctuating jaundice, cholangitis and weight loss are main symptoms. Mortality was one case in both
procedures. Histopathology were (29) well, (26) moderately and (9) poorly differentiated
adenocarcinoma. Chemotherapy was given to (17) of the resection group and (13) patients of the by-
pass group. The 2 and 5--year survival after by-pass alone was 44% and 8% compared to 68.6% and
31.4% in the resection group respectively. The size of the tumour, its grade and adjuvant
chemotherapy had influence on the prognosis.
CONCLUSION:
Ampullary or periampullary carcinoma can be dealt with by transduodenal resection as a curative or
palliative with results comparable to more radical procedures such as Whipple’s procedure.

BACKGROUND:
Adrenal disorders in surgical practice are presented either as hyperfunctional disorders or non functional
disorders (incidentalomas). Functionally, medullary tumors (pheochromocytoma) result in excess
secretion of catecholamines(1), on the other hand, functioning adrenocortical tumors could secrete excess
of cortisol (Cushing syndrome), aldosterone (Conn's syndrome) or sex hormones (virilizing
syndromes).(2) . Aim of our study was to identify the most common types of adrenal tumors, its
presentation and outlining the best diagnostic work up and to show our experiences in dealing with
adrenal disorders in Iraq.
METHODS:
This is a prospective study of 20 cases diagnosed as having adrenal disorders, admitted and evaluated in
Baghdad Teaching Hospital-Medical City from January 2002 to December 2004. The collected data
including; age, gender, presentations, methods of investigations and histopathological records.
RESULTS:
Their assessment revealed that adrenal disorders were most commonly encountered in the (30-39) years
age group (9/20, 45%). The mean age was 40 years with a female preponderance and female: male ratio
of 2: 1. Obesity was noted in (7/20, 35%). Headache was manifested in (5/20, 25%), palpitation in (4/20,
20%) and uncontrolled hypertension in (4/20, 20%). Plasma cortisol was elevated and its diurnal rhythm
was lost in (8/20, 40%), 24-urinary VMA was elevated in (6/20, 30%). 24-urniary 17-ketosteroid was
elevated in (1/20, 5%). The most commonly encountered clinical type of adrenal disorders was
hypercortisonism in the form of Cushing disease and syndrome (8/20, 40%).
CONCLUSION:
Adrenal disorders mostly affect young age group patients with a female preponderance. Functioning
adrenal disorders have presented earlier than non functioning ones owing to the symptoms they had
caused. U/S, CT scan, MRI and IVP are very important in visualization, localization, assessment of
distant metastases and finally discrimination of benign from malignant disorders.

BACKGROUND:
Cleft palate repair should be done with minimal tension across the suture line in order to avoid the
development of palatal fistula. Fracture of the pterygoid hamulus is routinely done by many surgeons
during cleft palate surgery to facilitate soft tissue approximation.
OBJECTIVE:
To demonstrate the actual need for fracturing the pterygoid hamulus in palatoplasty.
PATIENTS AND METHODS:
Seventy-one cleft palate patients were studied, their ages ranged between 16 months and 14 years .In
all of them surgical repair was done by Veau-Wardill- Kilner operation without fracturing of the
pterygoid hamulus .Dissection of the mucoperiosteal flaps from the underlying muscles was done to
overcome the tension and the clefts were closed in layers . The patients were observed for the ease of
the closure during surgery and the development of fistulas postoperatively.
RESULTS:
Closure can be obtained with minimal tension without fracturing the pterygoid hamulus even in wide
clefts if the flaps are properly released from the underlying muscular attachment. Postoperatively
three cases developed postoperative bleeding and 2 cases had palatal fistulas.
CONCLUSION:
Fracturing of the pterygoid hamulus is not indicated in repair of narrow to moderate clefts. In wide
clefts successful closure can be obtained without fracturing if adequate release of the flaps from the
muscles is done, otherwise fracturing might be justifiable to reduce the tension across the suture line.

IMMUNOLOGICAL EFFECT OF POLYSACCHARIDE
THE IRAQI POSTEGRADUATE MEDICAL JOURNAL VOL.5, NO.3, 2006
ABSTRACT:
BACKGROUND:
Visceral leishmaniasis is a serious disease with high pathoogenicity. It was noticed that Polysaccharide
extracted from Pseudomonas aeruginosa had the ability to induce both cellular & humoral immunity
response against bacteria, fungi & parasites.
OBJECTIVE:
The aim of this study was to know the immunological effects of polysaccharide extracted from
Pseudomonas aeruginosa before & after the infection of BALB/c mice with Leishmania donovani in trial
to provide a method for prevention of the disease in human.
METHODS:
174 male BALB/c mice were divided into control & experimental groups with each group consisting of
six animals. The experimental groups injected intraperitoneally (i.p) with 0.2 ml phosphate buffer saline
(PBS) containing 1×108 parasite. Cerdain groups were injected intraperitoneally by polysaccharide (PS)
at doses of 100, 150, 250 μg on day 3, 6, and daily for 6 days before infection with Leishmania donovani.
These animals were sacrified after 8 weeks. Other groups were injected intraperitoneally with
polysaccharides on day 7 post infection at the doses of 100, 150, 250, μg, 6 animals were sacrified after 2,
4, 6, 8 weeks. Total & differential count of leukocytes, measurement of spleen & liver weight and index,
measurement of cellular immune response, histopathological changes liver and spleen were carried out.
RESULTS:
This study showed an increase in the total count of leukocyte accompanied by an increase in lymphocyte
with decrease in monocyte percent in mice treated with polysaccharide before and after infection with
Leishmania donovani which were statistically significant. Reduction in liver & spleen weights & their
index in all treated groups was noticed before & after infection. The cellular immune response
represented by delayed hypersensitivity has been enhanced in the mice treated with polysaccharide before
&after infection. In treated groups, histopathological studies of mice showed hepatocyte hypertrophy,
infiltration of the inflammatory cells in liver before & after infection. In spleen showed an increase in
lymphocytes & monocytes in red pulp, while the infected mice (non treated) showed a necrotic foci, loss
of architecture of both liver & spleen & obvious granulomatous inflammation in liver.
CONCLUSION:
Polysaccharidde extracted from Pseudomonas aeruginosa induced immunological activity by activation of
cell mediated responses, stimulated an increase in WBC count & lymphocytes with minor histoptholgical
changes in liver and spleen

BACKGROUND:
Asthma is the most prevalent chronic condition among children . Both environmental and hereditary
factors are important in the pathogenesis of asthma .
OBJECTIVE:
To determine the severity of asthma among the asthmatic patients and its association with some
allergens .
METHODS:
A cross sectional hospital based study ; involved 120 patients suffering from asthma during the
period from Feb.- Aug 2003. A questionnaire was designed for the purpose as well as clinical
examination and serological study to asses the level of IgE against selected allergens .
RESULTS:
The study revealed that 53% of the patients were males . The most age group affected was (2-5) y ;
57(47.5%) of cases . The mild type of asthma is the predominant type; About 39 (32%) of the patients
suffering from mild intermittent asthma(MIA) and 53(44%) from mild persistent type . The main age
group affected by MIA was (2-5)y ;17(43%) patients. Patients with MIA were more sensitive to H1
allergens 12(40%) and least sensitive to F1 (3%). For moderate persistent asthmatic patients , they
were more sensitive to H2 8(34.7%) , then H1 6(26%). Patients from all age groups were sensitive
mainly to H1 ; (2-5)y: 18(36%) , for (>5-10)y : 10(38.5%) , for (>10-15)y : 7(33%). There was a
significant relation between the mild type of asthma and the family history of asthma , atopy , drug
and food allergy . The most important aggravating factor for the age group 2-5y was dust ; 17(
31%), while among the age group (5-10)y was exercise , 10 (31%). Among the age group (10-15) y
both dust and exercise were important factors 8 (29.6%) for each . Exposure to dust was a significant
aggravating factor for MIA 13(38.2%).
CONCLUSION:
Since the majority of patients suffering from mild type of asthma we recommend health education to
the parents and patients towards home management of asthma and avoidance of the allergens which
exacerbate the acute attacks .

BACKGRAOUND:
Acute leukemias are characterized by the elonogenic proliferation of hematopoietic progenitor cells
arrested in maturation .Clinical manifestations are related to the infiltration of the bone marrow and
other tissues by the leukemic blasts.
METHODS:
Peripheral blood mononuclear cell (PBMC) from leukemic patients (29)(ANLL),(36)(ALL) and from
normal donors(55)were typed for Human leukocyte antigen-DP specificities using
microlymphocytotoxicity assay.
RESULTS:
Results showed frequencies of (DPw) alleles in (ANLL) patients were not significantly different from
controls ,exept that in DPw1 was absent .In contrast ,in ALL,frequencies of DPw2 and DPw5 were
significantly increased (p< 0.05,relative risk (RR)= 1.95 and p<0.01,RR=4.27,respectively .
CONCLUSION:
These results ,demonstrate both positive and negative associations between major histocompatibility
complex (MHC) gene products which are in only very weak linkage with the rest of HLA ,and
(ALL,ANLL) patients.The HLD-DP region could thus contain long sought –after genes influencing
susceptibility and resistance to leukemogenesis

BACKGROUND:
To evaluate serum lipids in children with type 1 diabetes mellitus and its relation to glycemic control, in
comparison with sex and age matched non-diabetic children.
METHODS:
Fasting blood glucose, glycosylated haemoglobin (HbA1c) and lipid profile were estimated in 45 children
(20 males and 25 females) with type 1 diabetes attending diabetic clinic at Sulaymani children hospital
from the period of November 2005 till Jully 2006. Fifty health children (23 males and 27 females)
admitted to the same hospital with acute illnesses like respiratory tract infections were randomly selected
as controls.
RESULTS:
Mean total cholesterol, triglycerides, LDL-C, VLDL-C, and LDL-C/HDL-C ratio were significantly
higher in diabetic children compared to the control. However, there was no significant difference in the
levels of HDL-C in both groups .In addition to that, diabetic patients with poor control have a
significantly higher levels of blood glucose, total cholesterol, triglycerides, LDL-C and LDL-C/HDL-C
ratio as compared to those with good control. A significant correlation between most lipid variables and
HbA1c was observed in diabetic patients.
CONCLUSION:
Children with type 1 diabetes should be screened for serum lipids as significant lipid abnormalities are
related to glycemic control. Both can be improved with dietary guidelines and insulin therapy

BACKGROUND:
To evaluate serum lipids in children with type 1 diabetes mellitus and its relation to glycemic control, in
comparison with sex and age matched non-diabetic children.
METHODS:
Fasting blood glucose, glycosylated haemoglobin (HbA1c) and lipid profile were estimated in 45 children
(20 males and 25 females) with type 1 diabetes attending diabetic clinic at Sulaymani children hospital
from the period of November 2005 till Jully 2006. Fifty health children (23 males and 27 females)
admitted to the same hospital with acute illnesses like respiratory tract infections were randomly selected
as controls.
RESULTS:
Mean total cholesterol, triglycerides, LDL-C, VLDL-C, and LDL-C/HDL-C ratio were significantly
higher in diabetic children compared to the control. However, there was no significant difference in the
levels of HDL-C in both groups .In addition to that, diabetic patients with poor control have a
significantly higher levels of blood glucose, total cholesterol, triglycerides, LDL-C and LDL-C/HDL-C
ratio as compared to those with good control. A significant correlation between most lipid variables and
HbA1c was observed in diabetic patients.
CONCLUSION:
Children with type 1 diabetes should be screened for serum lipids as significant lipid abnormalities are
related to glycemic control. Both can be improved with dietary guidelines and insulin therapy

BACKGROUND:
To evaluate serum lipids in children with type 1 diabetes mellitus and its relation to glycemic control, in
comparison with sex and age matched non-diabetic children.
METHODS:
Fasting blood glucose, glycosylated haemoglobin (HbA1c) and lipid profile were estimated in 45 children
(20 males and 25 females) with type 1 diabetes attending diabetic clinic at Sulaymani children hospital
from the period of November 2005 till Jully 2006. Fifty health children (23 males and 27 females)
admitted to the same hospital with acute illnesses like respiratory tract infections were randomly selected
as controls.
RESULTS:
Mean total cholesterol, triglycerides, LDL-C, VLDL-C, and LDL-C/HDL-C ratio were significantly
higher in diabetic children compared to the control. However, there was no significant difference in the
levels of HDL-C in both groups .In addition to that, diabetic patients with poor control have a
significantly higher levels of blood glucose, total cholesterol, triglycerides, LDL-C and LDL-C/HDL-C
ratio as compared to those with good control. A significant correlation between most lipid variables and
HbA1c was observed in diabetic patients.
CONCLUSION:
Children with type 1 diabetes should be screened for serum lipids as significant lipid abnormalities are
related to glycemic control. Both can be improved with dietary guidelines and insulin therapy

BACKGROUND:
To evaluate serum lipids in children with type 1 diabetes mellitus and its relation to glycemic control, in
comparison with sex and age matched non-diabetic children.
METHODS:
Fasting blood glucose, glycosylated haemoglobin (HbA1c) and lipid profile were estimated in 45 children
(20 males and 25 females) with type 1 diabetes attending diabetic clinic at Sulaymani children hospital
from the period of November 2005 till Jully 2006. Fifty health children (23 males and 27 females)
admitted to the same hospital with acute illnesses like respiratory tract infections were randomly selected
as controls.
RESULTS:
Mean total cholesterol, triglycerides, LDL-C, VLDL-C, and LDL-C/HDL-C ratio were significantly
higher in diabetic children compared to the control. However, there was no significant difference in the
levels of HDL-C in both groups .In addition to that, diabetic patients with poor control have a
significantly higher levels of blood glucose, total cholesterol, triglycerides, LDL-C and LDL-C/HDL-C
ratio as compared to those with good control. A significant correlation between most lipid variables and
HbA1c was observed in diabetic patients.
CONCLUSION:
Children with type 1 diabetes should be screened for serum lipids as significant lipid abnormalities are
related to glycemic control. Both can be improved with dietary guidelines and insulin therapy