Iraqi Postgraduate Medical Journal

BACKGROUND:
Exposure to mildly cold environment was considered to be the cause of many children illnesses
during winter, or even during summer. Understanding these beliefs is essential for improving the care
of children.
OBJECTIVE:
To find out in what ways mild exposure to a cold environment was believed to affect children health
, and how did mothers respond.
METHODS:
Mothers of 200 children who brought their children to Al-Mansour Children Hospital , Baghdad, in
the period Jan.1st to April 30th 2002 were interviewed to fill a questionnaire form about the harmful
effect of mild cold exposure.
RESULTS:
The mothers held beliefs regarding mild cold exposure that ranged from causing coryza 96.5%, fever
96%, cough 94% , chest pain 85% , pneumonia 74% , to vomiting 88% , diarrhoea 95.5% and
abdominal colic 94% . The sources of exposure described included : giving a bath, inadequate
clothing , uncovering during sleep, walking barefooted , crawling on a cold floor , or taking a cold
drink or food .
CONCLUSION:
These beliefs lead to improper care of children including over warning or over clothing, while
distracting attention from useful measures like avoiding contact with infected persons or consumption
of contaminated food or drink .

BACKGROUND:
Cerebral palsy (CP) is a disorder of posture , movement & tone due to a static encephalopathy
acquired during brain growth in fetal life, infancy or early childhood.
OBJECTIVE:
To identify the risk factors of CP & its clinical patterns.
PATIENTS AND METHODS:
This case control study was done from the 1st of January 2009 to the end of September 2009, on 100
patients with CP who attended the neurology clinic or have been admitted to the neurology ward in
Children Welfare Teaching Hospital in Medical City complex, Baghdad. For comparative
purposes,100 control individuals matched for sex & age were selected. Some of those patients were
referred to pediatric clinic & registered with a diagnosis of CP & some of them were brought by the
parents or caregivers without referral for various complaints, then we reviewed their full history &
examination ( mainly neurological ) to confirm the diagnosis of CP. A specially designed
questionnaire form was used .
RESULTS:
Out of 100 patients with cerebral palsy, male:female ratio was (1.3:1), 89% of the patients were born
at term whereas 11% were preterm. Those patients were found to have history of normal vaginal
delivery in 70%, with one patient only delivered by assisted delivery, while 29% of them delivered
by caesarean section mode of delivery. History of intrauterine growth retardation found in 21%
patients, 4% were twin. The mothers of those patients had history of pre-eclampsia in 8% of the
cases, regular antenatal care in 65%, history of antipartum haemorrhage in 4%, premature rupture of
membrane in 13%. Abnormal presentation was found in 8%, cord prolapse in 4%, neonatal jaundice
in 62%, neonatal seizure in 8%, history of head trauma in 4% & history of central nervous system
infection in 20%. Spastic CP was the commonest type (67%), while mixed and atonic CP were the
least type (1% for each). Quadriplegic CP was the commonest topographical subtype (56%). Delayed
social milestone was found in 46% , speech difficulty in 94% , deafness in 2% , ocular problem in
29% , seizure in 58% & all of them had delayed milestone & weakness.
CONCLUSION:
Neonatal convulsion, neonatal jaundice, neonatal infection, antepartum hemorrhage & head trauma
are significant risk factors for cerebral palsy while precipitate labour, caesarean section, twins,
toxemia, breech delivery, low birth weight & cord prolapse were not found to be significantly
associated with cerebral palsy. The most common clinical pattern of CP was spastic quadriplegic CP.

BACKGROUND:
Neonatal deaths in Iraq account for more than half of under-five children deaths. The rates vary according
to causative factors in each area of the world.
OBJECTIVE:
To have an idea about death rates and major causes of neonatal death in Children Welfare Teaching
Hospital(CWTH), Medical City ,Baghdad .
PATIENTS & METHODS:
The medical records of 1074 neonatal deaths in Neonatal Care Unit(NCU)& surgical unit from 2005-2009
in Children Welfare Teaching Hospital, Baghdad , were studied retrospectively, especially for the cause
of death as registered in the files.
RESULTS:
Neonatal deaths relative to admission (15.1%) distributed between Neonatal Care Unit & surgical ward
into (11.38%) & (25.5%) respectively. Of 1074 total neonatal deaths, males were 653 (60.8%), 421
(39.2%) were females. Male to female ratio was 1:6. Major causes of death were: congenital anomalies
(53.2%), respiratory problems (20%) & neonatal infections (14%).
CONCLUSION:
The results of this study indicate that neonatal death rates are still high, with congenital anomalies being
the most common . More researches are needed to know the causes and the need for improvement in
neonatal care services .

BACKGROUND:
Although breast-feeding is highly appraised and widely practiced in Iraq, human milk supplies all
necessary nutrients except a few including vitamin D. Despite abundance of sunshine, vitamin D
deficiency rickets is not rare in Iraq.
OBJECTIVE:
We carried out this study with an objective to determine presence, presentation and predisposing
factors of rickets in pediatric patients attending Al-Kadymia Teaching Hospital-Baghdad.
METHODS:
This study was conducted in Department of pediatrics, AL-Kahdymia Teaching Hospital over one
year period from first of October 2008 to first of October 2009. Children from newborns to twenty
fourth months of age presenting with signs and symptoms of rickets were included and information
regarding signs, symptoms predisposing factors ( crowded housing, isolated housing with deficient
sun exposure, abundant sun but lack of awareness, malnutrition and antenatal factors ) and
investigations was recorded on a proforma. Diagnosis was based on clinical signs, radiological
changes on x-ray of wrist joint and biochemical disturbances in serum levels of alkaline phosphatase,
calcium and inorganic phosphorus.
RESULTS:
Sixty children with rickets reported during the study period. Overall, 40 infants (66.6%) were
exclusively on breast feeding. The main clinical presentation was in the form of recurrent lower
respiratory tract infection 30 infants (50%), recurrent diarrhea & delayed milestones 20 (33.3%) and
seizure 6 patients (10%). Skeletal changes on clinical examination were present in 30 (50%).
Radiological signs of rickets were present in 50 (83.3%). Symptoms and signs reverted to normal in
all cases after vitamin D supplementation.
CONCLUSION:
Nutritional rickets is still prevalent in Iraq, presenting with variable signs and symptoms,
predisposing the childhood population to different illnesses and skeletal deformities. In the presence
of abundant sunshine, lack of awareness of exposure to sun, may be the important predisposing
factors for development of nutritional rickets.

BACKGROUND:
Respiratory syncytial virus (RSV), historically being the major causative agent. RSV causes respiratory
disease in young children worldwide and by the age of two years most children have been infected.
OBJECTIVE:
The aim of this study was to investigate the effect of passive smoking alone and in conjunction with
breastfeeding and Crowding index and Family history of atopy in determining the risk of bronchitis in
Children under of 5 years of age .
METHODS:
We studied 100 consecutive Children aged from (1)day to (60)months (56boys and 44 girls),median age
30 months, who required hospital admission for acute bronchiolitis at the Pediatric Department ,Children
Welfare teaching hospital ,medical city complex - Baghdad.
The cases were compared with 100 patients at the same age groups with no history of Bronchilolitis .The
following parameters was studied in both groups: Exposure to passive smoking, type of feeding (Breast,
Bottle, and Mixed), Family history of atopy, and crowding index.
RESULTS:
High level of exposure to passive smoking on the other hand significantly increase the risk of having
bronchiolitis by (2.3) times compared to those with negative exposure. Breast feeding significantly
decrease the risk of having bronchiolitis by 5 times compared to those on mixed and bottle feeding.
A positive family history of atopy significantly increase the risk of bronchiolitis by (9.5 )times . Subjects
with moderately high crowding index (interquartile range )has 6.3 times of having increase the risk of
bronchiolitis compared to those of living in uncroweded residence (first quartile crowding index).Highly
crowding index (forth quartile)significantly increase the risk by 101 times compared to the those in un
crowded (first quartile )residence.
CONCLUSION:
Although Smoking , Lack of Breast feeding and family history of atopy are important risk factors for
RSV bronchiolitis But Crowding seems to be the most important risks factors for RSV bronchiolitis in
this study.

BACKGROUND:
We explored the effectiveness of enteric coated diclofenac sodiumfor patients with benign prostatic
hyperplasia (BPH) complaining of nocturia. A total of 30 BPH patients aged 50-75 years were
enrolled in the study. They each took a single 50-mg tablet of diclofenac sodium prior to sleeping at
night for 14 days in addition to their BPH treatments In the questionnaire ,21 of 30 patients
(70%) felt more satisfaction than previous treatments.
OBJECTIVE:
In this study, we attempted to investigate the role of enteric coated diclofenac sodium (voltaren) in
the therapeutic management of BPH patients with nocturia.
METHODS:
Thirty patient with BPH ( 63.6± 6.56 years old) more than two episodes of nocturia per night
were involved. These patients had received standard drug therapy. Although these patients had
received standard drug therapy for more than half a year, they had still three or more episodes
of nocturia. The patients took a single dose of 50 mg of diclofenac sodium enteric coated at
night prior to sleep. Before and 2 week after the initiation of this therapy, the effects of this
treatment were assessed by frequency volume chart and a questionnaire.
RESULT:
In the questionnaire ,21 of 30 patients (70%) felt more satisfaction than previous
treatments. Patients were grouped into a diclofenac sodium-effective (n = 23) and ineffective
groups (n = 7) based on the results of the frequency-volume chart. In the effective group,
interestingly, night-time urine volume showed significant reduction (P < 0.001). On the other hand,
the average single voided volume at night showed no significant change. There was a
statistically significant difference in the night-time urine volume after treatment between
groups (P < 0.05). In frequency volume chart, total void per day, total void per night, total
urine volume per day, total night urine volume per day and single voided volume in the
night before and after this treatment were 9.9±0.56and 10.1±0.69per day, 3.9±0.87 and
2.3±1.1 per night, 1500.2±106.9 and1508.7±107.3 mL per day, 580.2±136.9 and 350.4±169.3
mL per night, and 150±7.2 and 150.4±7.05mL, respectively, in a diclofenac sodium-effective
group.
CONCLUSION:
Diclofenac sodium can be effective and useful for BPH patients with nocturia.

BACKGROUND :
Varicoceles, present in 15% to 20% of men, are the most common abnormal finding among men
presenting with infertility.Despite the very long history of the disease and many records on different
surgical and radiological solutions, the ideal method of spermatic vein ligation for varicocele is still a
matter of controversy. The perfect technique would be one that preserves testicular function and
eliminates the varicocele with a low rate of recurrence, hydrocele formation and any other complications.
OBJECTIVE:
To assess the efficacy of laparoscopic Varicocelectomy for management of bilateral palpable varicoceles
in infertile males.
METHODS:
We analysed the result of 25 patients presented with history of infertility and diagnosed to have bilateral
palpable varicoceles treated in our department with Bilateral laparoscopic ligation of the spermatic
vessels between January 2009 and November 2010.
RESULTS:
The average operative (Bilateral Laparoscopic Varicocelectomy) time was 34 minutes. There were no
intra operative complications in the study group. Hydrocele formation was seen in 3 (6%) patients
recurrence was seen in one (2%) patient .The average hospital stay was 18 hours. postoperative analgesics
(1-2) doses , daily activities initiation usually started after 48 hrs and physical exercise 72 hrs . non of the
patient has developed an atrophic testis as a result of the laparoscopic procedure. eighteen patients (72%
)of the patients had improvement of the seminal fluid parameters During follow up period (6
months),with seminal fluid analysis, clinical and ultrasonic examination.
CONCLUSION:
Laparoscopic varicocele ligation is a simple and safe technique, causing minimal morbidity and enabling
rapid return to normal activity.

BACKGROUND:
Varicocele is an abnormal dilatation of pampiniform plexus within the spermatic cord. Varicoceles
are present in 15% of the normal male population and in up to 35-40% of patients with infertility. In
approximately 70-81% of patients with secondary infertility, a varicocele is an underlying cause. It is
a disease of puberty and is only rarely detected in boys less than ten years of age.
OBJECTIVE:
Is to evaluate the sub inguinal approach of varicocelectomy in infertile males with grade II and III
varicoceles.
METHODS:
A total of 150 patients were included in the study from 2004 to May 2010. Their ages ranged from 18
to 42 years. Fifty patients (33.3%) had grade II while 100 (66.6%) patients had grade III varicoceles.
All the patients had history of more than one year infertility (ranging from 14 to 36 months) and all
of them were sexually competent. Physical examination was performed with no apparent other
clinical cause of infertility. Although varicoceles were diagnosed primarily by physical examination,
color Doppler ultrasound was done for further documentation of the patient's condition. Only patients
with grade II and grade III primary varicoceles were included in the study with exclusion of those
with grade I varicoceles. Seminal fluid analysis and hormonal assay were done for all patients. Any
patient with sperm concentration below 10 millions / milliliter was also excluded. Sub inguinal
varicocelectomy was done for each patient. The operative time ranged from 20-25 minutes. The
patients were followed for one year.
RESULTS:
The overall pregnancy rate at one year was 66, 6 % .The time from the operation till pregnancy was
ranged from 4 to 12 months. Ten patients ( 6.6% ) developed recurrence , 2 patients ( 1.3% )
developed scrotal pain for 3 weeks postoperatively and then disappeared , and only 4 patients ( 2.6
% ) developed hydrocele .
CONCLUSION:
Whereas most male infertility surgeons now use the microsurgical approach, varicocele repairs can
be achieved with successful results and minimal complications without microsurgery as long as they
are carefully performed. Although microscopic sub inguinal varicocelectomy is better than non
microscopic one, the later can be done successfully with shorter operative time.

BACKGROUND:
Thrombolytic therapy is a standard treatment for patients presenting with acute myocardial infarction
(MI). Early administration of these agents is crucial for the outcome of management.
OBJECTIVE:
This audit was conducted to evaluate the time between arrival to emergency department (ED) and the
administration of thrombolysis (door to needle time).
METHODS:
Data was collected from patients admitted to the Coronary Care Unit of Al-Yarmook Teaching Hospital
,with a diagnosis of acute MI and received thrombolytic therapy over a one-year period (April 2009 to
April 2010). The time between arrival to the ED to the time of administration of thrombolytic therapy
was obtained as well as the time of onset of chest pain up to presentation to the hospital, and the
outcome (all cause mortality) post treatment.
RESULTS:
A total of 271 patients (256 males) admitted to the Coronary Care Unit of Al-Yarmook Teaching
Hospital with a diagnosis of acute MI received thrombolytic therapy over a one-year duration. The
median door to needle time was 95 minutes. The median time of onset of chest pain to arrival to ED
was 5 hours (300 minutes). The outcome of these patients obtained either alive was 260 (96%) or dead
was 11 (4%) (P < 0.00001).
CONCLUSION:
The door to needle time was relatively similar to other centers. Delay in presentation to the hospital was
more important and factors contributing to this delay should be looked for and corrected. Another audit
is needed to evaluate the implementation of these recommendations.

BACKGROUND:
Fat cells, are the cells that primarily compose adipose tissue, specialized in storing energy as fat.
Adipose tissue also serves as an important endocrine organ by producing hormones such as leptin,
resistin, and the cytokine. Leptin is a protein hormone that plays a key role in regulating energy
intake and energy expenditure, including appetite and metabolism. Acute Myocardial Infarction
(AMI), is the interruption of blood supply to part of the heart, causing some heart cells to die.
OBJECTIVE:
To investigate the levels of leptin and its effect on lipid profile level in Acute Myocardial
Infarction.
SUBJECTS AND METHODS:
The study included 50 patients with Acute Myocardial Infarction and forty healthy subject as
control group. leptin and lipid profile levels were measured.
RESULTS:
The levels of leptin were significantly elevated in female patients group with(p=0.002), in male
patients group(p=0.018) and in total patients group (p=0.001), cholesterol and LDL-C were
significantly elevated with (p<0.001), while HDL-C was significantly lower with (p<0.001), there
was positive correlation between leptin with , cholesterol LDL-C, triglyceride and VLDL, and
there was negative correlation between leptin with HDL in acute myocardial infarction patients.
CONCLUSION:
Leptin negatively correlated with HDL and positively correlated with triglyceride and LDL this
relation make this hormone act as atherosclerotic factor.

BACKGROUND:
Diabetes mellitus (DM) is a common, chronic and complex metabolic disorder. Its direct and indirect
effects on the vascular system are major causes of morbidity and mortality.
OBJECTIVE:
To verify the effects of diabetes mellitus on clinical presentation and angiographic findings in diabetic
patients with ischemic heart disease as compared to non diabetic patients.
PATIENTS AND METHODS:
This cross-sectional descriptive study was conducted in the Iraqi Center of Heart Diseases during the
period from November 2008 till June 2009. Two-hundred patients with ischemic heart disease (IHD) who
were referred to the Iraqi Center for Heart Diseases were randomly included. Clinical history and
examination were done; blood tests, electrocardiography and echocardiography were done for all patients.
Patients were classified into 2 groups: 68 patients with diabetes mellitus and 132 patients without diabetes
mellitus. Coronary angiography was done for all patients and the results were interpreted by two
independent interventional cardiologists.
RESULTS :
There were 145 (72.5 %) males and 55 (27.5 %) females. The mean age of study population was 56.92 ±
3.9 years (56.57 ± 3.2 years for males, 57.91 ± 4.1 years for females).There were no statistically
significant differences between diabetic and diabetic patients regarding sex, age, type of clinical
presentation, presence of hypertension and family history of coronary heart disease. Diabetic patients
were more likely to be smoker (61.7% vs. 48.4%, P = 0.01), to have dyslipidemia (53% vs. 35%, P =
0.03), left ventricular systolic dysfunction (61.7% vs. 48.4%, P = 0.045) left ventricular diastolic
dysfunction (92.6% vs. 58.3%, P =0.03), more diseased coronary arteries (38.2% vs. 25.7%, P =0.009),
more frequent left main stem involvement (13.2% vs. 3.8%, P =0.008) and more complex coronary
lesions (60.2% vs 31.8%, P =0.00002).
CONCLUSION:
Diabetic mellitus has clear adverse effects on left ventricular systolic and diastolic functions and
angiographic findings in patients with ischemic heart disease.

BACKGROUND:
Fibromyalgia syndrome (FMS) is a common rheumatologic syndrome with multiple manifestations
and associated with many diseases, it characterized by chronic wide spread muscular pain and
tenderness. Further, circulatory levels of pro-inflammatory cytokines like IL-8 and others may be
altered in FMS patients, possibly associated with their symptoms.The objective of the study is to
measure IL-8 concentration and to evaluate its role in the pathogenesis of primary FMS.
OBJECTIVE:
Fifty patients with primary FMS were included in the study (37 females and 13 males) the age range
of (17-65) years (Mean ± SD) (40.13 ± 12.0) years, and thirty healthy individuals volunteers (21
females and 9 males), whose age and sex matching with FMS patients, age ranging (18 - 63) years,
(Mean ± SD) (36.1 ±10.0) years.
METHODS:
IL-8 concentration was measured in sera of patients and controls by ELISA kit. Anthropometric
measurements like body mass index (BMI) and waist circumference (WCr) were taken ,besides other
features like sleep disturbance , emotional distress , and fatigue were reported.
RESULTS:
IL-8 concentration was higher in FMS patients than controls(40.24±22.0) pg/ml vs. (19.16±7.8)
pg/ml. This elevation was highly significant statistically (p=0.000).Other measurements in patients
group like BMI, WCr were(28.39±5.0) Kg/m2 and (100.34±13.21) cm respectively .These values
were highly significant when compared to their control group (p=0.002)and (p=0.008) respectively
.Clinical features like sleep disturbance, emotional distress ,and fatigue showed highly significant
difference between the two groups . No significant differences were reported with respect to age and
sex.
CONCLUSION:
The result of the current study suggest that interleukin-8, (IL-8) might have a role in the pathogenesis
of FMS.

BACKGROUND:
Fibromyalgia syndrome (FMS) is a common rheumatologic syndrome with multiple systemic
manifestations & associated with many diseases.
OBJECTIVE:
To assess fibromyalgia syndrome in inflammatory bowel disease.
PATIENTS AND METHODS:
One hundred four Iraqi patients with inflammatory bowel disease were studied and compared with
another (112) healthy individuals matched for age and sex as a control group. Full history was taken
and complete clinical examination was done for all individuals in both groups. Fibromyalgia
syndrome was diagnosed in all patients on base of the American College of Rheumatology (ACR)
1990 Criteria for the classification of FMS. Inflammatory bowel disease was detected by
colonoscopy & tissue biopsy.
RESULTS:
There was a significant increase in the frequency of FMS among individuals with IBD (24 %)
compared to healthy control group (5.4%) ((P-value =0.0001, Odd ratio=0.18, 95% CI=0.07-0.46).
CONCLUSION:
FMS occurs with increased frequency in IBD.

BACKGROUND:
Dyslipidemia is a common health problem.
OBJECTIVE:
The present study was to estimate the prevalence of dyslipidemia as defined by the NCEP ATP3
criteria among people living in Karbala city.
SUBJECTS AND METHODS:
The investigations were performed on a sample of 130 subjects selected arbitrarily from those
attending the public clinic in AL- Hussainy teaching hospital in Karbala for consultation and from
some subjects accompanying the patients. Fasting blood samples for routine lipid analyses from each
subject were obtained after informing them about the project and having their approval.
RESULTS:
In this sample of subjects it was found that 72.3% of them had a plasma TC level lower than
200mg/dl. This study also determined a prevalence of hypertriglyceridemias in 23.3% of study
subjects who have a borderline TG level. The prevalence of high and very high TG among them
were 6.9% and 4.4% respectively. The frequency of LDL-C levels above 160 mg/dl was found to be
about 1% of the sample. Borderline levels of LDL-C was found in 7.3%of the sample. In the
meantime the prevalence of low HDL-C levels in this study was found to be 39.2% of the subjects
who had a serum level of HDL-C less than 40mg/dl.
CONCLUSION:
In conclusion this study demonstrated a very high prevalence of dyslipidemia among Iraqi adult
subjects living in Karbala city. A public health strategy for prevention, detection and treatment of
this disorder is needed.

BACKGROUND :
Percutaneous image-guided drainage is the first-line treatment for infected or symptomatic fluid
collections in the abdomen and pelvis, in the absence of indications for immediate surgery and
considered potentially a life saving therapeutic surgical procedure in high risk patients .
OBJECTIVE:
To evaluate the efficacy of US-guided percutaneous drainage in treating intra-abdominal abscesses and
fluid collections
PATIENTS & METHOD :
Patients with intra-abdominal collections underwent percutaneous drainage under ultrasound (US)
guide were studied prospectively in the Gastro-enterology and hepatology hospital in baghdad from
April 2008-Sept 2009. The procedure done under local anesthesia & aseptic technique, needle access
obtained before placing the catheter .Peritoneal Dialyses catheter was used in our study.
RESULTS :
There were 43 patients (29 females and 14 males ), Age ranging 8-67 years. The collections
diagnosed basically on US in 33 patients ( 76.7% ) & US and CT-scanning needed in 10 (23.3%).
These collections were post-operative in 36 patients (83.7%) and primary (spontaneous) in 7
(16.3%)The post-operative cases were as follow:18 patients (50 % ) operated on for gall bladder
diseases, 6 (16.7 %) for abdominal trauma ,4 ( 11% ) for acute abdomen , 4 ( 11% )for Hydatid cyst,
2 (5.6 %) colonic surgery and one patient (2.8 %) operated on for acute appendicitis and one (2.8%)
after ERCP. Twenty three (53.5 %) of the collections were single & 20 (46.5%) were multiple. The
single collections were located as: Right Hypochondrial(Right subphrenic,Subhepatic and Hepatic) in
15 patients (65.2 %), Epigastric in 4(17.4 %),2 of them were pancreatic, Pelvic in 3 (13 % ) , and
paracolic in one patient ( 4.4 % ). Six patients(14 %) have hepatic collections, 4 of which were
following Hydatid Cyst Surgery, the remainder were Pyogenic hepatic abscesses. Material drained was
Bile in 24 patients ( 56 %),Pus in 17(39.5 %) & blood and urine in one patient (2.25 %) for both,
Fourteen patients (32.6%) underwent more than single drainage procedure, nine of them (64.3 % )
twice , three (21.4 %) three times& two (14.3% )more than 3 re-interventions.
The operations has been avoided in 26 patients (60.5 %) but was not avoidable in 17 ( 39.5% ),
because of the ultimate need of the condition for operation in 15 patients (88 % )and failure of drainage
in 2 patients ( 4.7 %)
CONCLUSION:
US guided drainage is an efficacious therapy for intra-abdominal collections and have become the
treatment of choice for a wide variety of collections. It helps to obviate or delay a major surgery.

BACKGROUND:
Skin loss of perinioscrotal region may result from severe infections, avulsion trauma or crush wounds.
Replacement with sensible durable cover is mandatory for functional, cosmetic and psychological
reasons. Wide range of flap techniques have been reported for these purposes.
OBJECTIVE:
To evaluate the use of superomedial fasciocutaneous thigh flap for replacement of scrotal and penile
skin loss.
PATIENTS AND METHOD:
7 male patients aged between 25 and 69 years(mean=53.4) were included in this study. All of them
presented, in the period between2007-2010,with scrotal and penile skin loss. Four of them were with
Fournier's gangrene, one was with history of agriculture accident, one with crush wound, and the last
one was with penile skin loss after improper use of penile clamp. Superomedial fasciocutaneous thigh
flaps were planned, elevated at subfascial plane, then transferred to close the wounds. Bilateral flaps
were used in five patients for total scrotal reconstruction. All patients were followed for 3-13 months.
RESULTS:
12 flaps were used for the 7 patients with complete survival. These provided nice durable covers of the
testes with good sensation. The flaps were moderately bulky in one patient. Other complications
included serous fluid collection in one patient, wound dehiscence in two patients, paresthesia of the
anterior aspect of thigh in 2 patient, and mild leg edema in one patient. All complications were transient
and responded well to conservative treatment.
CONCLUSION:
Superomedial fasciocutaneous thigh flap is a good choice for scrotal and penile reconstruction that
could provide a sensible, durable cover that fulfills patient satisfaction.

BACKGROUND:
Fasting during the month of Ramadan is one of the five holy pillars in the Islamic faith and is an
important annual ritual practiced by all Muslims. This involves fasting from dawn to dusk,
followed by a break of fast at designated times. The length of fasting varies from ten to 19 hours,
depending on the season in which the fasting month of Ramadan falls and the geographical
locations.
OBJECTIVE:
1st to evaluate the relation between Ramadan fasting & duodenal ulcer perforations & 2nd to asses
the risk factors of this complications .
PATIENTS & METHODS :
This is a prospective study in Baghdad Teaching Hospital – Medical City . Data from 231
consecutive patients with perforated duodenal ulcer from the period of October 2007 to December
2010 were collected & analyzed & all the patients were managed surgically after resuscitation in
emergency unit .
RESULTS :
(96/231, 41.6%) of patients with perforated duodenal ulcer during Ramadan vs. (135/231, 58.4%)
during the rest of the years . (96/490, 19.5%) of patients with perforated duodenal ulcer from the
total number of all patients with acute abdomeninal surgeries during Ramadan. 43 % of patients
smoking & 47 % of patients had a previous history of acid peptic disease in Ramadan. 54 % of
patients were in between (20 to 40) years age group and the male to female ratio was 6 :1 . 15%
patients of perforated duodenal ulcer had history of regular use of non steroidal anti inflammatory
drugs.. Erect chest x-ray demonstrated gas under the diaphragm in 86% . Only 2 patients had a
previous surgery of duodenal ulcer perforation .
CONCLUSION:
This study suggests that the incidence of duodenal ulcer perforation is relatively high in Ramadan
among the people, who are fasting & have predisposing factors ( smoking , history of acid peptic
disease , non steroidal anti-inflammatory drugs ) and need special precaution during this month .

BACKGROUND:
Kidney transplantation has been established as the most efficient treatment of end stage renal
disease with the advantage for the patient to live a nearly healthy life.
Surgical complications are common in both the immediate postoperative period and later after
kidney transplantation. But these complications when managed accordingly had no effect on the
graft survival.
OBJECTIVE:
We studied the incidence and management of early surgical complications; that occurred within the
first month after transplantation, in 213 kidney transplanted patients.
PATIENTS AND METHOD:
A cross sectional descriptive study including 213 patients with renal failure underwent allograft
kidney transplantation from October 2003 to October 2010, in the renal transplant center, medical
city teaching hospital, Baghdad. Focusing on the incidence and management of early surgical
complications; that occurred within the first month after kidney transplantation.
RESULTS:
213 patients, 144(67.6%) were males, 69(32.4%) were females. The age range of the donors was
18y - 55years (mean 30.39±9.32), While the age range of the recipients was 7y – 66y (mean
31.40±11.35). 121(56.9 %) were unrelated donors, 92 (43.2%) were related donors.
The reported surgical complications were, urinary tract infection in 80(37.5%) patients, Urine leak
8(3.8%), Lymphocele 2(0.9%), Wound seroma 2(0.9%), Wound hematoma 1(0.5%), Wound
infection 1(0.5%), Small bowel injury 1(0.5%), Acute pancreatitis 1 (0.5%), acute gastric erosion 1
(0.5%), Postoperative bleeding 1 (0.5%), Deep venous thromboses 3(1.4%), Intemal dissection of
the renal artery with the formation of intemal flap 1 (0.5%), Arterial thromboses 1(0.5%) peroperatively, Venous thromboses 1(0.5%) per-operatively, No mortality, or graft loss happened
because of these surgical complications. The one-month patient survival was 98%, and graft
survival was 97%.
CONCLUSION:
Surgical complications occur in both the immediate postoperative period and later after kidney
transplantation. But these complications had no effect on the graft survival, when managed
accordingly.

BACKGROUND :
Gynecomastia is a benign enlargement of the male breast.
OBJECTIVE:
Was to analyze a 3 year period of gynecomastia patients in Al-Kindy Teaching Hospital and the
surgical approach used and its outcome.
PATIENTS AND METHODS:
A prospective study of patients consulting Al-Kindy Teaching Hospital because of gynecomastia
between October 2007and August 2010 was done. Data were analyzed for etiology, grade of
gynecomastia, surgical technique, complications, and histological results.
RESULTS:
A total of 64 patients with 86 operations were included. Techniques included subcutaneous
mastectomy alone, or subcutaneous mastectomy with wise pattern "inverted T incision". Atypical
histological findings were found in 3.12% of the patients (papilloma, fibrolipoma). Surgical revision
among all patients was 7%. Body mass index higher than 25kg/m2 was found as significant risk
factors for complications (p\0.043), and that higher grades of gynecomastia (grade IIb and III )had
higher statistical incidence of complications p= 0.01
CONCLUSION:
The treatment of gynecomastia requires an individualized approach. Caution must be taken in high
BMI and higher grades, which are associated with increased complication rates. Histological tissue
diagnosis should be routinely performed in all true gynecomastia corrections, because histological
results may reveal atypical cellular pathology.

BACKGROUND:
Matrixmetalloproteinases (MMPs) are a class of matrix basement membrane degrading enzymes which
were shown to be associated with metastases in several human tumors.
OBJECTIVE:
This study is aimed to investigate the potential effect of MMP-9 in imparting the frequently reported
different behavioral pattern between jaws and long bones osteosarcomas.
METHODS:
Tissue blocks of ten cases of jaws osteosarcomas and another ten of long bones osteosarcomas were
collected and stained immunohistochemically with monoclonal antibodies to MMP-9.
RESULTS:
The majority of cases (70%) were positive for MMP-9 expression which indicates a role in tumor spread,
however; there was no significant difference between the sites.
CONCLUSION:
The study indicates that MMP-9 is probably not involved in the biologic differences between jaws and
long bones osteosarcomas.

BACKGROUND:
Telemetry is defined as simultaneous video and EEG monitoring of presumably epileptic patients
while they are hospitalized in telemetry ward so that one or more of the habitual seizures or funs are
captured and recorded; these events would be visualized and analyzed later by expert epileptologists
for the sake of proper diagnosis, classification, presurgical evaluation or else.
OBJECTIVE:
To define and evaluate simultaneous Video –EEG monitoring in epilepsy management.
METHODS:
Two hundreds consecutive telemetries at King's College Hospital in London over the period of nine
months starting from Jan 2007 back to May 2006 were reviewed and the conclusive yields were
evaluated.
RESULTS:
It showed that the three main indications for referral were to be ’the diagnosis' in a proportion of
56.5% 'presurgical evaluation ' in 19.8% and ' classification' in 15.2% whereas other application like
assessment for vagal nerve stimulation (VNS) candidacy , sleep studies , follow up and frequency
estimation constitute the remaining 8.5 % . It was conclusive in 63% for 'classification', 60 % for
'diagnosis', and only 34%for presurgical evaluation, whereas categorically was conclusive in 56.55 of
all referrals.
CONCLUSION:
The study shows that telemetry is a crucial and probably an indispensable tool if the proper
understanding of the problem, and consequently proper handling and management are to be
considered.

BACKGROUND:
The phenomena of negative symptoms of long stay schizophrenic patients were studied at AL- Rashad
Mental Teaching Hospital for three hundred patients one hundred fifty females and hundred fifty
males.
OBJECTIVE:
To identify the prevalence of negative symptoms in long stay schizophrenic patients, and to study the
relationship of negative symptoms with sociodemographic factors.
PATIENTS AND METHODS:
A cross sectional study and semi –structured psychiatric interview based on ICD 10 criteria together
with a symptoms check list were used to assess the negative symptoms among our sample, during seven
months from first January to first August 2007.
RESULTS:
The results revealed that all those patients had negative symptoms ,and the commonest one in male
patients was poor self care (83%) , followed by marked apathy(66.7%) ,while in female patients ,the
commonest was non verbal communication(80%),followed by blunted affect(74%) .
CONCLUSION:
The negative symptoms were very common in long stay schizophrenic patients. And there is different
gender distribution.

In Iraq , DNA Typing Profile has been added to the
routine work of disputed paternity cases as a
powerful tool of investigation in Forensic in 2007.
The old conventional investigation based on blood
antigen systems like variable blood groups , HLA
Tissue Typing was no more used in such sensitive
cases because of the limitation or invariability of
loci analyzed.
We report here the first case of paternity test done
for a trios (Alleged father , mother and child)
rebated by two old and new techniques . The
alleged father has been excluded from being a
biological father according to the mismatch in
ABO, MN blood group &5 genetic markers in
DNA profile between the alleged father &son.

BACKGROUND:
A lot of debate about wild cherry is published especially it’s hypoglycemic and antioxidant effects, this
study is conducted to see the histological, biochemical and morphometrical changes in rats pancreas.
OBJECTIVE:
Wild cherry possesses a mild stimulatory action on pancreatic islets. Also it can be regarded as protective
to islets of Langerhans in diabetic rats.
MATERIAL & METHODS:
Fifteen Rats were employed in this study. they were divided into 3 groups (5 normal controls, 5 given
alloxan, 5 Treated with cherry herbs after given alloxan).
RESULTS:
The normal control group resulted , no abnormalities in pancreatic tissue , while the group of alloxan rats
showed marked reduction in the diameter of islets of langerhans with necrosis cells, it also showed
increase in blood sugar (as compared with the control Group ). The wild cherries group showed
apparently normal pancreatic tissue and islets of langerhans diameter, also normal blood sugar (as
compared with the alloxan group).
CONCLUSION:
Islets cells destruction was evident after alloxan administration, while protection action was prominent
after wild cherry in diabetic rats.