Iraqi Postgraduate Medical Journal

BACKGROUND:
Endotracheal intubation is one of important step during the administration of general anesthesia. It is
more so in pediatric patients with associated deformities like cleft lip and palate. Propofol, with its
profound depressant effect on the airway reflexes, has a quick and smoother induction. Similarly,
halothane is least expensive volatile anesthetic, sweaty to inhale and because of its safety profile.
OBJECTIVE:
The intubating conditions with the use of intravenous propofol is superior to inhalational halothane with
oxygen for tracheal intubation without muscle relaxants in children who undergo cleft lip surgery.
PATIENTS AND METHODS:
In this prospective randomized study, 50 ASA I patients who where aged three to nine months, who
were scheduled for cleft lips surgeries were included. Both group received halothane 3% by face mask
with monitors attached [pulse oximeter , ECG ,NIBP ]. I.V line inserted ,first group(propofol group) once
patients become sleepy &respiration became regular& stop movement they received 2mg/kg propofol
&E.T.T attempt within 0ne min.2nd group inhalational( halothane Group) until pupil been central &
constricted &E.T.T attempted within 5 min. The intubation conditions were assessed by using Steyn’s
modification of the Helbo - Hansen intubating conditions score.
RESULTS:
The intubating conditions were better in group A than in group B. The group A patients (88%)
significantly had more clinically acceptable intubating conditions than in group B(52%), (p=0.0015) .
CONCLUSION:
The intubating conditions with the use of intravenous propofol 2mg/kg is superior to inhalational 3%
halothane with oxygen for tracheal intubation without muscle relaxants in children who undergo cleft lip
surgery.

BACKGROUND:
Ketamine shows beside its general anesthetic effect, a local anesthetic - like action; that is due to
blocking of Na+ channels mainly with other proposed mechanisms.
OBJECTIVE:
Comparison of ketamine local anesthetic action with that of bupivacaine in neuraxial blockage (spinal
anesthesia) was done.
PATIENTS AND METHODS:
Hundred patients were scheduled according to American Society of Anesthesiologists (ASA) physical
status classification I-II for elective inguinal hernia surgery under spinal anaesthesia, divided into 2
equal groups, the first group received 2 ml (0.5%) bupivacaine, second group received 2 ml [75 mg
preservative free Ketamine (1.5 ml) mixed with 0.5 ml, 30%dextrose], comparison in the onset,
duration of the sensory block and the central sedative effect between the two groups was done.
RESULTS:
Group II patients who received ketamine intrathecally demonstrated faster onset of block with longer
duration of analgesia, 30% of them appeared sedated owing to the central sedative effect.
CONCLUSION:
As a new look to an old drug; ketamine can be used as a pure local anesthetic for spinal anesthesia with
the advantage of longer period of analgesia and faster onset as compared with bupivacaine. Ketamine
group appeared more hemodynamically stable.

BACKGROUND:
Delivery of baby by caesarean section has become increasingly common, Caesarean section can be
performed under general or regional anaesthesia like spinal or epidural technique, and both have
advantages and disadvantages. It is important to clarify what type of anaesthesia is safest for the
mother and baby.
OBJECTIVE:
To compare the effect of spinal anaesthesia versus general anaesthesia on Apgar score of neonates
born by elective caesarean section in Baghdad teaching hospital.
MATERIAL AND METHODS:
The study was carried out in Baghdad teaching hospital from February 2011 to July 2011 .this
study was performed on 60 women presenting for Elective lower segment caesarean section .thirty
mothers were given general anaesthesia and other 30 mothers received spinal anaesthesia. The
Apgar score was recorded at1 minute and 5 minute interval after each delivery.
RESULTS:
Out of 30 mothers, who received general anaesthesia, 25 patients (83.3%) give birth to neonates
having Apgar score ≤ 6 at one minute after birth and the remaining 5 neonates (16.7%) had Apgar
score of ≥7.
On the other hand out of 30 mothers who received spinal anaesthesia only 10 mothers give birth to
neonate having Apgar score ≤ 6 at one minute after birth, who improved at 5 minutes interval, and
their Apgar score were ≥7.
It had been found that those neonates who were born under G.A were ten folds more likely to have
Apgar score less than or equal to 6 at first minute compared to those with spinal anaesthesia, the
odds ratio=10 and 95%confidence interval of the odds ratio (2.94-34) and p=0.00024 which is
highly significant, G.A had greater risk on infant at the first minute.
CONCLUSION:
There is a significant difference between the effects of general anaesthesia and spinal anaesthesia
on Apgar score of neonate one minute after delivery of full term neonate by elective caesarean
section, but there is no significant difference between the effect of general anaesthesia and spinal
anaesthesia on Apgar score 5minutes after birth.

BACK GROUND:
Day case surgery issurgery where patient returns home on same day of surgery, saving resources,
money decreases in-patients number with rapid turnover. Question about the ideal type of
anasthesia for such surgery is of interest of many studies.
OBJECTIVE:
To comparing time to discharge after perianal surgery for patient received spinal anasthesia versus
patients received general anasthesia, sample was taken between February 2007,and July 2010, in a
private day clinic in Baghdad.
PATIENTS AND METHODS:
Study included 200 patients ASA(I-II), age 18-60 years. One hundred patients had been received
spinal anasthesia with small dose lidocaine 2%, other 100 were received general anasthesia with
either propofol or pentothal.
RESULTS:
Indicate thatspinal anaesthesia with small dose lidocaine achieves shorter time to discharge patients
versus general anasthesia; mean time for spinal anasthesia was 105.69min and for general
was147.57 min.
CONCLUSION:
Spinal anaesthesia is a good option for outpatient surgery in comparison to general anasthesia
regarding time to discharge patients, and we can achieve better results by simple manipulation in
techniques and drug dosage which might decrease unwanted side effects of S.A.

BACKGROUND:
Multiple myeloma (MM) is caused by the malignant proliferation of plasma cells through the bone
marrow. The clinical features are due to disordered immunoglobulin synthesis and/or secretion from
the cell. The amount of protein in the vascular compartment depends on the balance between the
rate of synthesis and catabolism or loss. Electrophoresis is a technique that separates compounds
such as proteins according to their different electrical charge. In this way, five main groups of
proteins namely albumin and the α1, α2, β, γ-globulins, may be distinguished after protein staining
and may be visually compared with those in a normal control serum.
OBJECTIVE:
To evaluate total serum protein, serum albumin, serum globulin, and serum protein electrophoresis
in Iraqi MM patients.
PATIENTS AND METHODS:
This study was conducted during the period from August 2012 until the end of November 2012. The
patients were admitted to Medical City Hospital and all the measurements were performed in the
Medical Teaching Laboratories in Baghdad. Total serum protein was measured by colorimetric
Biuret method, while serum albumin was measured by bromocresol green method, serum globulin,
and serum protein electrophoresis were measured in 25 patients with MM; their age range was (50-
70) years and compared with 25 healthy controls.
RESULTS:
Total serum protein and serum globulin were significantly increased (86.76±17.05 g/l and
55.36±20.54 g/l respectively) in patients with MM, as compared with their controls, (P=0.0001).
While a significant decreased was found in serum albumin (29.6±8.77 g/l) and albumin to globulin
ratio (0.64±0.36 g/l) for patients with MM as compared with their controls, (P=0.0001).
CONCLUSION:
Abnormal concentrations of total serum protein, serum albumin, serum globulin, and M-band are
associated with MM.

BACKGROUND:
Tuberculosis (TB) is a disease that has affected humankind throughout recorded history and
before.Presently, the number of deaths caused by TB worldwide exceeds that caused by any other
organism.
Drug-resistant tuberculosis is a man-made problem. Poor management can lead to the selection of
M. tuberculosis with mutations conferring resistance to antituberculous drugs.
Drug resistance is divided into two types: primary (resistance in persons who have never received
anti-tuberculosis drugs for more than 1 month. These patients are initially infected with drugresistant strains) and secondary, acquired, (resistance to anti-tuberculosis drugs, which arises
during treatment due to poor compliance or improper management.)
OBJECTIVE:
To identify the prevalence of drug resistance among new cases of pulmonary tuberculosis in Iraq.
METHODS:
A cross sectional studywhich includes, 106 patients fulfilled the criteria of inclusion throughout the
duration of the study, and sputum samples were taken from all of them for direct microscopical
examination and culture and drug sensitivity.
RESULTS:
Fifty patients (47.2%) had positive results for mycobacterial culture, none of them showed
resistance to any anti- tuberculous drug that had been examined for, i.e. : all the 50 samples were
sensitive to tested anti-tuberculous drugs
CONCLUSION:
standard first line treatment for pulmonary T.B. is recommended for all new cases of pulmonary
tuberculosis in Iraq.

BACKGROUND:
Visceral Leishmaniasis (VL) is a systemic infection of the reticulo- endothelial system that could
affect on immune system and biochemical parameters like the concentration of trace elements which
may be significantly changed .
OBJECTIVE:
Evaluating the level of cytokines (INF- γ ,IL-10) and concentration of Zn in Visceral Leishmaniasis
in children after diagnosis .
PATIENTS AND METHODS:
A total of (98) child their ages rang (6m-5y) were attending to the Central Public Health Laboratory
and Teaching Laboratories of Medical City suspected to be infected with kala-azar, the diagnosis
was done by both IFAT technique and Rapid Kala-azar (r-K39) detecting test and evaluating the
level of cytokines (INF- γ, IL-10) by ELISA and concentration of trace element ( Zn ) by Atomic
Absorption Technique .
RESULTS :
The dipstick test ( r-K39) showed a high sensitivity of (92.1%) compared to IFAT (73.6%) with a
specificity of 100% for both tests. Serum samples of 56 child with positive results in IFAT and rK39
test were used for the investigation of IL-10, IFN-γ. The mean levels of IL-10 (80.207±77.54 Pg/ml)
and IFN- γ (5.426±4.599 IU/ml) were highly significant increased in patients compared to healthy
controls .The mean level of serum Zn (69.71±7.97μg/dl) was significantly low in VL patients
compared to healthy controls .
CONCLUSION :
This study showed that the ( r-K39) dipstick test could be more sensitive than IFAT technique in the
diagnosis of VL with a specificity of 100 % for both test according to clinical diagnosis. Both IFN-γ
& IL-10 were significantly increased in VL patients as compared to controls group. The
concentration of Zinc was significantly lower in VL patients than healthy controls.

ABSTRACT:
BACKGROUND:
Testicular relapse in ALL usually appear as painless testicular enlargement mostly unilateral.
Diagnosed by wedge biopsy. The testis is a frequent site of relapse.
OBJECTIVE:
To find out the incidence of testicular relapse in ALL, time of diagnosis of testicular relapse, age
group more commonly associated with testicular relapse, the association of testicular relapse with
other relapses (medullary or extra-medullary), and prognosis of patients with testicular relapse.
PATIENTS AND METHODS:
Aretrospective study in the central teaching hospital of children in Baghdad- unit of hematology
and oncology, during January 2000 – December 2006.
Two hundred-four males were studied retrospectively. Informations were obtained from patients'
files.
RESULTS:
The incidence of testicular relapse was in 18 patients represented (8.8%) of total cases of boys with
ALL below 15 years. Relapse is mainly unilateral in 15 patients (83.3%) and mostly in the right
side in 11 patients (61.1%) of total cases with testicular relapse.
There is no significant statistical incidence of relapse with the age of patient represented by 2 cases
(6.2%) from (0-2 years), 11 cases (8.2%) from (2-10 years), and 5 cases (13%) more than (10
years). Time of diagnosis of relapse was mainly during the oral maintenance therapy (13) patients
(72.5%).
Testicular relapse was isolated in 8 patients (44%) and combined with other relapses in 10 patients
(56%) of them 7 patients (39%) with bone marrow relapse and 3 patients (17%) with CNS relapse.
The outcome of patients with testicular relapse was better after discontinuation of chemotherapy
“after three years of treatment” (2 cases diagnosed with relapse both of them still alive) represented
(100%), while during the maintenance therapy of 13 patients, 6 (46.2%) of them still alive, 6
patients (46.2%) of them died, and 1 patient (7.6%) with no report, while induction chemotherapy
2 cases 1 (50%) alive and 1 (50%) died).
Patients with isolated testicular relapse had better outcome represented by 6 patients (75%) still
alive and 2 patients (25%) died, patients with combined relapse had worse outcome, represented
by 3 patients (30%) alive, 5 patients (50%) died, and 2 patients (20%) with no report.Incidence of
testicular relapse significantly decreased after the introduction of more intensive chemotherapy in
Jan 2004 from 9.8% to 3.1%.
CONCLUSION:
Incidence of testicular relapse decrease with introduction of intensive chemotherapy and had higher
incidence during the maintenance therapy, associated with increased incidence with other
medullary and extra-medullary relapses, and has better prognosis when it is late and isolated than
for early and combined relapse.

ABSTRACT:
BACKGROUND:
Type 1 diabetes mellitus is a chronic autoimmune disease that involves destruction of the pancreatic
beta cells. It is well known that both genetic and environmental factors involved in pathogenesis of
type-1diabetes mellitus.
OBJECTIVE:
This study seeks to determine whether there is any association between human leukocyte antigen
class I and II alleles and type-1diabetes mellitus.
SUBJECTS AND METHODS:
Seventy type-1 diabetes mellitus patients compared to 30 apparently healthy individual were enrolled
in this study. Human leukocyte antigens genotyping were analyzed by polymerase chain reaction
sequence specific oligonucleotide technique.
RESULTS:
The present study revealed significantly high frequency of DQB1*0101 and DQB1*0201 alleles
among patients in comparison with healthy control, while there was significantly low frequency of
each HLA-A*3301, B*0826, DRB1*0701, *1101 and HLA-DQB1*0604 alleles in patients as
compared to healthy controls.
CONCLUSION:
These findings indicate that higher frequency of HLA-DQB1*0101 and *0201 alleles may be a risk
factor for type-1diabetes mellitus, meanwhile low frequency of HLA-A*3301, B*0826, DRB1*0701,
*1101 and HLA-DQB1-*0604 alleles could be a protective factor.

BACKGROUND:
High energy pelvic ring fractures are serious injuries result from motor vehicle accidents or fall
from height, unstable pelvic ring injuries usually associated with sacroiliac disruptions or sacral
fractures. The ideal treatment for unstable pelvic fractures remains a matter of debate. The main
purpose of the treatment is to save the patient s life and then to achieve an excellent functional
outcome. Percutaneous fixation of Sacroiliac joint disruption or sacral fractures is evolved recently
as a minimal invasive technique with low complication rate and morbidities.
OBJECTIVE:
A preliminary study to evaluate prospectively the effectiveness of the percutaneous cannulated
screws fixation of posterior pelvic ring injures in unstable fractures with associated injuries .
PATIENTS AND METHOD:
Six patients have been treated in Medical City/Baghdad (during the period of Jan.2012 till July
2012) by one surgeon, four males and two females with mean age 27 years (range 20-36 years),
who have unstable pelvic ring injuries associated with other skeletal, neural or visceral injuries are
treated by gradual closed reduction using skeletal traction through lower femur and percutaneous
sacroiliac fixations using a 7 mm Cancellous partially threaded screws following the technique
described by Matta and Saucedo using C-arm fluoroscopy. A data for the duration of procedure,
blood loss, intra-operative and post-operative complications and post-operative rehabilitation were
collected analyzed and compared to data for open reduction and internal fixation for the same
injuries from other studies . pre and post-operative radiographs and CT scans of the pelvis were
studied to evaluate the procedure.
RESULTS:
A total of 13 screw where inserted percutanously to a six patients . The duration of the surgical
procedure was 30 minutes to 60 minutes including the preparation time. Wound size was 5mm-
10mm, Blood loss was negligible, no anesthetic complications no intra or post-operative
complications, no wound complications, and a very good post-operative rehabilitation. postoperative X-rays and CT scans show no complications and a very good reduction and fixation for
the Sacroiliac joints and sacral fractures.
CONCLUSION:
Gradual closed reduction and Percutaneous sacroiliac fixations using cannulated screws have
demonstrated a very good minimally invasive technique with no intra-operative or post-operative
complications. This technique may be advantageous as it avoids using extensive approaches,
bleeding, wound complications and prolonged surgeries.

BACKGROUND :
Unstable pelvic ring fracture (PRF) constitute 17 – 23% of pelvic fracture , it occurs as a high –
energy injuries , and usually associated with multiple concomitant injuries. The mortality has been
reported between 18 – 25%. Conservative treatment carries a high rate of complication. Recent
studies recommended surgical stabilization by open reduction and internal fixation (ORIF).
OBJECTIVE:
Evaluate the functional outcome, morbidity and mortality rate in the patients treated by anterior and
posterior fixation of (PRF).
PATIENTS AND METHODS:
This is a prospective study on 23 patients sixteen male and seven female , age range 18 – 50 years
with unstable PRF were operated upon by (ORIF) , there were 12 patients with sacro – iliac joint
(SIJ) dislocation and 8 patients with SIJ fracture – dislocation , three with sacral fracture , various
implants used for stabilization assessment of the outcome based on patients oriented score of Majeed
scale , follow up period range 14 – 37 months postoperatively.
RESULTS :
The functional outcome were as follow using Majeed's scale as excellent in 12 patients (52%) good in
5 (21%) and moderate in three (13%) and poor in one ( 4.7%) . Two patients died during follow up
period (8.6%). There was statistical significant relation between the severity of injury and low grade
outcome.
CONCLUSION:
Early ORIF of unstable fracture of pelvic ring is recommended.

BACKGROUND:
Dynamic hip screw is still one of the most widely used devices for the fixation of femoral
intertrochanteric fractures. A recognized complication with this device is the screw cut-out from
the femoral head.
OBJECTIVE:
Of this study is to assess if the tip apex distance is a reliable predicting factor for the subsequent
lag screw position and so the outcome of femoral intertrochanteric fractures fixed by dynamic hip
screws.
Design of the study: Prospective Cohort Study.
PATIENTS AND METHODS:
42 patients (27 female, 15 male), with an average age of 63 years, (ranging from 55 to 72
years),with stable intertrochanteric fractures of the femur treated by dynamic hip screws. All
patients were investigated and optimized for surgery. Good and accepted closed reduction was
done under fluoroscopic control with the use of orthopedic table. Dynamic hip screws were
inserted by a standard technique. Tip apex distance for every case was measured by immediate
postoperative plain x-ray.Patients were reviewed clinically and radiologically on 2nd, 6th, 12th, and
24th weeks.
Setting: department of orthopedic-medical city complex and private job.
RESULTS:
There were 30 cases (71.4 %) with tip apex distance below 25 millimeters. Only 1 case of them
ended with mechanical failure. And there were 12 cases (28.6 %) with tip apex distance more than
25 millimeters. 5 cases out of these 12 cases ended with mechanical failure. So the mechanical
failure represented 41.7 % when the tip apex distance was more than 25 millimeters while it was
3.3 % when the tip apex distance was below 25 millimeters. The two-tailed P value equals 0.0047
CONCLUSION:
it is concluded that the tip apex distance is a strong predicting factor for the mechanical failure of
stable intertrochanteric fracture of the femur fixed by dynamic hip screw.

BACKGROUND:
The otologic symptoms are frequents in temporomandibular joint (TMJ) disorder due to the
proximity of the ear to the temporomandibular joint, TMJ pain can often be confused with ear pain.
OBJECTIVE:
To verify the frequency of otic signs and symptoms with TMJ disorder.
Study design: descriptive and transversal.
MATERIALS AND METHODS:
Thirty five patients, with pain complaint in tragus and peritragus area from otorhinolaringology
department in Aljamhori Teaching Hospital in Mosul-Iraq. Patients with ear infection, even with
TMJ disorder were selected and the ones with TMJ disorder with otalgia. Then sent to
maxillofacial department to examine the TMJ. The data obtained were subdivided into two groups:
TMJ disorder patients with otological exam in normal condition and TMJ disorder patients with
abnormal otological condition.
RESULTS:
Thirty five patients, 14 men and 21 women aging from 18 to 75 years .There were 19 patients had
TMJ disorder with otological examination in normal condition. Otalgia and TMJ tenderness were
(89.74%) masticatory muscle tenderness (78.68%) and TMJ sound (63.15%), followed by itching
and tinnitus (42.1% both). In second group all 16 patients with ear problems had TMJ tenderness
(100%), were otalgia and itching (81.25%, 68.75%) respectively.
CONCLUSION:
The signs and symptoms most frequently associated with ear and TMJ disorder were TMJ
tenderness, masticatory muscle tenderness- especially lateral pterygoid and temporalis -and click
associated with otalgia; itching and tinnitus respectively. The results provide additional support for
the notion that a relationship between temporomandibular disorder and otologic signs and
symptoms does exit.

BACKGROUND:
Growing evidence indicates that serum Anti-mullerian hormone (AMH) levels could be of great
importance for understanding the relationship with oocyte quality for IVF. The aim of the present
study was to investigate the role of serum level of AMH in differentiation of infertile female
patients with good quality oocytes, who are good responder and ready to enter the IVF cycles.
OBJECTIVE:
This study included 25 infertile females classified into two groups: (15) females with Tubal
obstruction and 10 females with polycystic ovary syndrome (PCOS). Also, nineteen fertile
females were served as controls.
METHODS:
Investigation included serum measurements of AMH, Inhibin B, FSH, LH, E2, Prolactin and
TSH on day 3 of previous menstrual cycle, serum measurement of progesterone (P4) on day 21
of previous menstrual cycle (before starting ovulation induction). Also AMH, Inhibin B and E2
were measured on day of hCG administration (after long ovulation protocol).
RESULTS:
The mean (±SD) value of serum AMH was significantly decreased in female patients after
ovarian stimulation protocol compared to that before ovarian stimulation,(P< 0.01). Also, the
mean (±SD) value of serum AMH of female patients with good quality oocyte was significantly
higher than that of those with bad quality oocyte, (P<0.01).
CONCLUSION:
This study revealed that measurement of serum AMH is good marker in prediction of good
responder infertile females for IVF technique after ovarian stimulation protocol.

BACKGROUND:
Intrauterine devices are highly effective methods of contraception; but considered to cause pelvic
inflammatory diseases by its colonization by bacteria and /or fungi and form biofilms consisting
of layers of host cells and bacteria or fungi embedded within a matrix material.
OBJECTIVE:
To screen the microbial biofilms on intrauterine devices, and its associated infection in vagina and
cervix in intrauterine devices users.
METHODS:
A case series design was adopted, composed of 50 participants. High vaginal and cervical swabs
were taken and intrauterine devices were removed and sent for microbiological examination.
RESULTS:
Eighty four percent of removed intrauterine devices were infected with biofilm containing different
types of microorganisms and 92.8% of these infected IUDs were associated with high vaginal and
cervical infection.
E.coli was found to be most common microorganism 61.5% of the infections, staphylococcus
aureus 43.6%, Pseudomonas spp. 15.3%, candida albicans 10.3%, Neisseria gonorrhoea 5.1%.
CONCLUSION:
There is high frequency of microbial biofilms formation on intrauterine devices and also high
percentage of associated cervico-vaginal infections in intrauterine devices users.

BACKGROUND :
The incidence of rheumatoid arthritis[RA] varies from country to another which not depend on
genetic bases alone but can explained by environmental exposure and genetic and environmental
interaction, area of military conflict ,there was stress induced pathway that elevates the risk for
rheumatoid arthritis, in Iraq rheumatoid was 1% of population in 1975.
OBJECTIVE:
To evaluate incidence of RA in Babylon –Iraq from 2001-2011
PATIENTS AND METHODS:
This study was done to examine the incidence of RA in Babylon between 2001-2011 by
Retrospective cohort study in Merjan Teaching Hospital ,Rheumatology unit .Data included sex
.birth year ,residency and latex test , from 2001 to 2011.All patients were diagnosed as Rheumatoid
Arthritis according to American College of Rheumatology ACR 1987revised criteria of RA .the
numbers of patients of RA who were received DMRADs included methotrxate therapy were recorded
each year and incidence of each year was found then the cumulative incidence was calculated.
RESULTS:
There were1039 patients with rheumatoid arthritis from 53786 patients in rheumatology unit. 50.1%
living in urban area while 49.9% in rural area. The incidence in 2001 was 1.60 while in 2011 was
3.02 for the same population and the cumulative incidence in 2011 was22.74. Latex test was 52%
in2001 while in2011 was 58% in rheumatoid patients in the same year. The P value for age mean
difference between female and male was [0.009].
CONCLUSION:
The incidence of RA was increasing from 1.60% in 2001 to 3.02% in 2011 and the cumulative risk
wasb22.74% in Babylon –Iraq.

BACKGROUND:
Percutaneous nephrolithotomy (PCNL) for renal calculi is one of the more challenging
endourologic procedures.PCNL remains the procedure of choice for most stones that are more than
2 cm in size, complex staghorn calculi, some lower-pole stones, stones in caliceal diverticuli, and
larger renal stones that are refractory to shock wave lithotripsy( SWL).
OBJECTIVE:
The purpose of this study was to evaluate the outcomes and complications in patients who were
undergoing PCNL for renal calculi at our center.
PATIENTS AND METHODS:
From January 2011 to December 2012, a total of 216 patients who had renal stones underwent
PCNL by the same surgical team at our institution. All patients were evaluated preoperatively with
intravenous urography (IVU) and/or computerized tomography(CT). Data analysis included
procedure time, length of hospital stay, number of access tracts, transfusion rates, other
complications, and stone-free status. Percutaneous access was performed using C-arm fluoroscopy
with patients in the prone position. The access tract was dilated with a balloon dilator or Amplatz
dilators. Fragmentation of the stone burden was accomplished using an Ultrasonic lithotripter. No
patients in this series underwent a tubeless technique. Nephrostomy tube was placed at the end of
procedure and nephrostogram done in all patients on 2nd postoperative day.
RESULTS:
Mean age was (42.43±13.17) yrs. The mean stone burden was (6.91±4.47)cm2 .The average
procedure time was( 57.40±21.05) minutes. Mean pre and postoperative hemoglobin(Hb) levels
were(13.43±1.34) and ( 11.71±1.86) g/dl respectively and Hb drop was ( 1.76±1.10) g/dl.PCNL via
a single access tract was accomplished in( 93.51%) of procedures, while multiple tracts and
intercostal access were used in( 4.62%) and (1.85% ) respectively of procedures.Mean fluoroscopy
time during the whole procedure was (1.75±0.90) minutes.Mean hospitalization was (3.52±0.86)
days. Stone-free rates at hospital discharge and at 3 months follow-up were (81.44%) and
(92.07%), respectively. 30 patients received blood transfusion (13.88%).
CONCLUSION:
PCNL is a safe and effective procedure for the management of renal stones. It has the advantages
of lower morbidity, shorter hospital stay. The full of array of endourologic equipment and expertise
remains essential to achieving a successful outcome.

BACKGROUND:
Laparoscopic management of the high intra abdominal testis is still a matter of controversy.
Laparoscopic Fowler-Stephens orchidopexy (FSO) is performed either by one stage (laparoscopic
clipping and division of the spermatic vessel and proceed for orchiopexy at the same time) or by
two stages FSO (laparoscopic clipping and division of the spermatic vessel only and performing
laparoscopic release of the testis along with orchiopexy 3-6 months later ).
OBJECTIVE:
To study the outcome of Laparoscopic one stage and two stages FSO for the management of high
intra abdominal testes.
PATIENTS AND METHODS:
A prospective comparative clinical Study included 25 patients (21 unilateral and 4 bilateral non
palpable abdominal testes , 29 testes in total) and laparoscopic surgical procedures (One stage
FSO was done for 18 testicles and Two stages FSO was done for 11 testicles) were performed at
the urology department ,Medical city complex, Iraq , during the period between December 2010
and March 2013 . Their mean age was 3.2 years.
The comparative criteria include; Time of surgery, postoperative complications, testicular position,
and testicular viability.
RESULTS:
Testicular Doppler study revealed four atrophied testes of one stage F.S.O. (22.2%), two
atrophied testes among two stages FSO group (18 %) ,this difference was statistically non
significant . The difference in the proper scrotal position also was not significant. The operative
time difference was significant between both groups (86.6 ± 10.1 min. for one stage vs 122.7 ±
13.5 min. for two stages FSO).
CONCLUSION:
One-stage FSO avoids repeated anesthesia and the potential for extensive, sometimes tedious,
dissection that is occasionally required during re operation, and shorter operative time, making it
more optimal than two stages FSO.

ABSTRACT:
BACKGROUND:
Wilson’s disease (WD) is an inherited defect in copper metabolism that causes accumulation of
copper in various body organs. It is a treatable; if it is diagnosed promptly and treated consistently.
OBJECTIVE:
Laboratory; hematological, biochemical, and diagnostic evaluation of a sample of Iraqi patients
with WD, and study any association between clinical presentations and studied variables.
METHODS:
A case series study was conducted during 2011, from the 1st of February till the 10th of June.
Sampling method was a convenient non-random one, through consecutive pooling of registered
WD patients. A questionnaire-form paper had been developed for data collection, and required
investigations were done in qualified laboratories.
RESULTS:
The study had enrolled 29 patients, with a male to female ratio of (1.07:1), The mean hemoglobin
level was 10.64±2.53g/dl. Hemolysis was presented in 27.6% of patients, normochromicnormocytic RBCs in blood film were seen in 3.4% patient, platelet count was
243.97±89.35ccX109/L, WBC count was 5.70±2.84ccX109/L. ESR was 24.98±17.16mm/hr., serum
bilirubin was 6.17±5.18mg/dl, serum cholesterol was 146.21±44.93mg/dl, serum triglycerides was
95.34±52.23mg/dl. Total serum protein was 72.86±11.15g/L, serum Albumin 39.17±7.88g/L and
serum Globulin 31.07±7.89g/L. Penicillamine challenge test was positive in 96.6% patients. Serum
ceruloplasmin level was 123.38±48.48mg/L, total serum copper was 72.48±25.11µg/dl, and 24h
urinary copper excretion was 174.97±109.58µg/24hr.
CONCLUSION:
Most patients with WD are; anemic, with low serum levels of copper and cerulloplasmin, positive
penicillamine challenge test, with abnormal liver function tests. With detected hemolysis in some
of them; though no statistical difference or association was approved regarding laboratory values
among patients with different presentations.
.

BACKGROUND:
The prognostic biomarkers in a disease provide information regarding outcome irrespective of
therapy .Her-2/neu oncogene expression is an important prognostic and predictive marker for breast
cancer .Her-2 /neu expression can be determined by immunohistochemistry ,which became a routine
investigation to predict the response to tamoxifen therapy. There is evidence that over-expression of
Her-2 /neu is involved in breast cancer progression and there is suggestion that Her-2/neu overexpression plays a role in the early stages of breast tumorigenesis .
OBJECTIVE:
To evaluate Her-2/neu over-expression in breast carcinomas in the studied sample and to assess its
immunhistochemicalscore status in term of accepted conventional clinicopathological parameters .
PATIENTS AND METHODS:
This is a descriptive study which was carried out from 2007-2012 on 64 breast carcinoma specimens.
Paraffin embedded tissue of patients underwent modified radical mastectomy with axillary clearance
were processed for Her-2/neu assessment from almost all breast patients in the province .
Then the evaluation of the staining and assigning a score were performed which ranged from 0 -3
.The tumor grade was asses using modified Bloom-Richardson grading system .Data on the patients
age , the size of the tumor and lymph node status were obtained .
Statistical analysis were produced by the use of Chi square test and at the level of significant alpha <
0.05 to compare the IHC results for HER-2 expression with the prognostic clinicopathological
parameters .
RESULTS :
HER-2 over expression was seen in 23.5% (15/64) and the lymph nodes involvement status had a
significant association with the immunhistochemical score for HER/2 oncogene and no siginificant
association seen between HER-2 overexpression and other clinicopathological parameters including
age , tumor size and tumor grade.
CONCLUSION :
The study reveals that the prevalence of HER-2 overexpression in breast cancers is less in our study
compared with the western world and demonstrates association of the immunhistochemical score of
HER-2 /neu with some of the well-established pathological parameters of breast carcinoma , specially
lymph node involvement. It justifies the use of the immunhistochemical score in assessing breast
carcinoma and modified its treatment .

BACKGROUND :
Beck Depression Inventory (often abbreviated asBDI) is an instrument to measure the severity and
depth ofdepression symptoms. BDI was developed in a novel way for its time by collating patients'
verbatim descriptions of their symptoms and using these to construct a scale which could reflect
the intensity or severity of a givensymptom.
OBJECTIVE:
To measure the validity of Beck depression Inventory short version using ICD 10 criteria for
major depression as a gold standard
METHOD AND PATIENTS :
The study was carried out in IbnRushd and Baghdad Teaching Hospitals. The sample was selected
purposely among patients diagnosed to have major depressive disorder according to the ICD- 10
criteria for major depressive disorder. For each patient a clinical interview was done using the ICD
10 criteria for major depressive episode after being given beck depression inventory – short
version in a paper
RESULTS :
The overall result indicates ‘fair to good’ agreement between both Beck and ICD-10 suggesting
that Beck Depression Inventory is valid in assessing the degree of severity of depression
CONCLUSION:
Beck Depression Inventory short version (13 item ) is adequate in assessing the severity of
depression in patients with ICD-10 diagnosis of depression

BACKGROUND:
Patient satisfaction is generally considered as extend to which the patient feel that their needs and
expectations are being met by services provided. Satisfied patient are more likely to maintain consistent
relationship with their care provider leading to improved compliance and better health outcomes.
OBJECTIVE:
To evaluate the patient satisfaction to hospital services and identify factors that influences this
satisfaction.
PATIENT AND METHODS:
Cross sectional study of 60 patients who were interviewed using a questionnaire that includes
information under six main heading; 1) Patient general information; 2) Satisfaction about physician; 3)
Satisfaction about nurses; 4) Satisfaction about pharmacy ; 5) Satisfaction about laboratory services ;6)
Satisfaction about ventilation and cleanliness .
RESULTS:
More than half of satisfied patients were among those of ≥50 years old, female, and the majority of
satisfied patients were among un-employed and those with single reason for admission. Statistical
analysis showed a significant association between the reason for admission and patients satisfaction .
CONCLUSION:
The satisfaction of elderly was high and more in female, un- employed and less with those who
admitted for more than one reason.

Pregabalin is a newly introduced medicine which
is an analogue to Gaba pentin and similar to its
structure, it was approved by the FDA in 2004
and marketed by Pfizer company under the name
of LARYICA.
It has been described in various medical
disorders among which are: neuropathic pain as
that of diabetes (1,2), post herpetic neuralgia (3),
seizure disorders (4) and anxiety state (5).
Pregabalin the first medicine approved for
treatment of
fibromyalgia by the FDA (6,7) Pharmacologically
Pregabalin bind to alpha 2 delta subunit of the
voltage-dependent calcium channels in the
central nervous system, it also decrease the
releases neurotransmitters such as glutamate,
noradrenalin and
the substance P (8,9).
Though FDA label indications are; diabetic
peripheral neuropathy, fibromyalgia, Post
herpetic neuralgia and as an adjunct in seizure,
yet Pregabalin have been Used in many other
conditions on empirical bases as a treatment of a
single case
Or more as in post operative Pain (10) or hot flash
(11) beside other diseases.
Herewith I am reporting an unusual clinical
observation never been described before, the
Night Muscular cramps in the Legs collegially
known as "Charley hoarse" known by Iraqis as
"ABU SLSHERGATE"

Excessive ineffective erythropoiesis in
thalassemia intermedia may cause paravertebral
pseudotumors of extramedullary hematopoiesis.
Due to the proximity to the spinal canal, these
paravertebral masses carry the risk of severe
neurological damage. Treatment strategie include
hypertransfusion, radiotherapy, and
laminectomy.Hydroxyurea, stimulating fetal
hemoglobin synthesis, may represent an
alternative therapeutic approach. This
presentation report a case of female known to
have thalassemia intermedia who presented with
abnormal gait with weakness of lower limbs.
MRI study showed masses originate from thorax
vertebra. Hypertransfusion therapy and
splenectomy were followed by regular
transfusion (baseline hemoglobin 10 g/dl) and
chelation with desferrioxamine. With this
treatment, clinical symptoms disappeared,
paravertebral ematopoietic masses did not
progress, Hydroxyurea therapy was initiated to
reduce the required transfusion volume but
suppressing concomitantly further expansion of
extramedullary hematopoiesis, and finally
leading to a reduction of transfusional iron load.
Treatment was started with 4 mg/kg per day and
stepwise increased to 20 mg/kg per day. . Follow
up to the patient done by clinical examination and
imaging study to assess the vertebral masses.