Annals of the College of Medicine Mosul

objective: To assess plasma atrial natriuretic peptide (ANP) level in pregnant and
preeclamptic women, and to evaluate the role of this hormone in the defense mechanism
against body fluids and electrolytes disorders encountered under such physiological
and pathophysiological conditions.
Design: A case- series study.
Setting: Al - Batool Teaching Hospital for Gynecology and Obstetrics, Mosul, during the period from December 2003 to September 2004.
Participants: Twenty five women with normal pregnancy (group I ), 25 pregnant women with
preeclampsia (group ll ) and 25 healthy non pregnant women (control group) were included in this study.
Methods: Plasma ANP, serum creatinine, urea, sodium and potassium were measured in all
groups. unpaired -t-test was used to examine the difference in the mean of the studied
parameters between different groups. Pearson correlation was used to assess the relation
between different parameters within each group.
Results: The mean of plasma ANP level was significantly higher in group I (p<0.05) and group
ll (p<0.0001) than that in the control group. Furthermore, the plasma ANP level was
significantly higher in group ll (p<0,0001) than that in group l. The mean of serum creatinine
and serum urea were significantly higher in group ll than that in group l (p<0.005 and p<0.0001) and control group (p<0.0001 and p<0.0001).
Conclusion: The results of this study indicate that plasma ANP level significantly increases
during pregnancy especially among those who develop preeclampsia. Since ANP plays an
important role in the maintenance of body fluids and electrolytes homeostasis and blood
pressure regulation, estimation of plasma ANP level may be of value in better understanding
and management of pathophysiological conditions that challenge the body homeostatic
mechanisms during pregnancy.
Key words: Atrial natriuretic peptide, preeclampsia.

objective: To study the causes of failure (canal wall down) mastoidectomy procedure.
Design: A prospective case series study.
Setting: ENT department, Al-Jamhory teaching Hospital during the period of May 1996 to May 2000.
Participation: Twenty five patients underwent canal wall down operation over a period of four years. They were reviewed for the final result after the operation.
Results: Fifteen patients were noticed to have complete dryness and healing. Eighty percent of the patients get dry ear within the first three months after the operation. failure to get healed cavity was seen in patients with large cavities, high facial ridge and inadequate meatoplasty.
conclusion: Recognition -of the possible causes of failure to get dry ear, the surgeon\'s
experience and the regular follow up of the patient, may help in achieving better results.

Context: Bronchiectasis is a relatively common disease in developing countries, The pathogens responsible for its acute exacerbations vary from one area to another.Objectives: To study the characteristics of patients with bronchiectasis in Northern lraq, and to identify the types of pathogens responsible for the acute exacerbations.Design: Case series study.Setting: Respiratory Care Unit and general medical wards in lbn-Sina Teaching Hospital inMosul, during the years 2002-2004.Patients and Methods: Fifty patients with bronchiectasis (16 males and 34 females) presenting during an acute exacerbation underwent clinical and radiological evaluation with sputum Gram (Gm)stain and culture.Results: The cause of the disease was readily identifiable in 367o of patients. Tuberculosis was the predominant aetiology. Streptococcus pneumoniae and klebsiella pneumoniae were the commonest pathogens. Gm negative bacilli were responsible for 36% of cases overall, and were especially important in those with long standing disease (≥15 years) Pseudomonasaeruginosa was related to more extensive disease. Most of the isolates were sensitive tociprofloxacin and cefotaxime.conclusion: Gm negative bacilli should be considered in antibiotic selection during acuteexacerbation of bronchiectasis, especially in long standing and extensive disease.Keywords: bronchiectasis, Gram negative bacilli

Objectives: To identify the different pathological types of malignant tumors of nasal cavity\' and paranasal sinuses, their different clinical aspects, treatment received and prognosis in north of Iraq.Design : Retrospective study.Settings: Files of patients treated in the hospital of oncology and nuclear medicine in Mosulover 15 years period (1980-1994).Main outcome measures: Types, incidence, age and sex distribution, anatomical sites, clinical presentation, staging, method of treatment and prognosis.Results: They constituted 0.51% of all malignancies and 2.13 % of head and neck cancers.Sinus tumours affected both sexes equally as well as both sides. Nasal cavity tumours weremore common in male (male/female=1.4/1) and in the right side (right/left=1.33/1).Thecommonest age at presentation was the fifth decade.The most common presenting symptom was facial and nasal pain with average delay indiagnosis of about 8.5 months. Tumours of epithelial origin formed the majority ofcases (85.68%).All maxillary and ethmoidal cases were advanced at time of diagnosis (T3 or T4), while 60%of nasal cavity tumours were T1 and T2. 21.87% of patients had palpable cervical lymph nodes at presentation.The majority of patients received radiotherapy alone, few cases had surgery alone or both, but prognosis was generally unsatisfactoryconclusion: Malignant tumours of nose and sinuses are rare in north of lraq, are usuallyadvanced at presention , and carry poor prognosis.keywords: Malignant Tumours , Nasal Cavity , Paranasal Sinuses

Objective: To evaluate the role of tympanometry in predicting middle ear effusion by comparing results with the operative findings.
Design: A descriptive study concerned with 105 ears (57 patients) diagnosed as middle ear
effusion by tympanometry; type B, flat curve; that underwent myringotomy operation (with or without ventilation tube insertion).
setting: Department of ENT-Al-salam Teaching Hospital/Mosul for the period (April 2003 to September 2004). Tympanometry was performed in the Outpatient Clinic of Al-Jamhoori
Teaching Hospital.
Subjects: The study included 36 males and 21 females with a ratio of 1.7:1. The average age
was 6 years with a range of 3-12 years.
Methods: The parameters analyzed included age, sex and tympanometric results. Matching
between the suspected ears for middle ear effusion; type B, flat curve; and the operative
findings (fluid found in the middle ear at the time of myringotomy) was recorded.
Results: The diagnostic accuracy and examination success rate of tympanometry; type B, flat
curve; in predicting middle ear effusion was 71.4%. Moreover, the sensitivity, specificity, positive and negative predictive values were 97.2% , 57.3%,55.3% and 97.5% respectively. Thus, the positive likelihood ratio was 2.3.
Conclusion: The accuracy rate of tympanometry in predicting middle ear effusion showed a fair validity for its exclusion. The use of pneumatic otoscopy and tympanometry together improves the accuracy of diagnosis.
Key words: Tympanometry, middle ear effusion, myringotomy.

Objective: To determine the precipitating risk factors for diabetic ketoacidosis (DKA) from medical and social points of view as well as risk of prolonged hospital stay.
Methods: Forty-eight patients were admitted to Basrah Maternity and Child Hospital for DKA. Over a 2 years period; September 2001 through to September 2003. Patient\'s age, sex and family socioeconomic status were identified. Duration of hospital stay was examined, prolonged duration of stay was defined as ،ف 7days.
Results: Forty eight patients with DKA, their ages ranged between 1 and 15 years, with a male to a female ratio 1.3:1.
More than half of the children (58.4%) were males and (60.5%) were from low social status. Poor compliance to continue the treatment and infections were the most common precipitating factors, being responsible for 54.2% and 25% of cases of DKA respectively
Children with prolonged hospital stay were significantly found to be of younger age and of low socioeconomic status.
Conclusions: DKA is still a commonly seen complication; it can be the presenting feature of
diabetes. Poor compliance and inadequate treatment are the leading precipitating factors in our patients.

objective: To examine the plasma level of atrial natriuretic peptide(ANP) in patients with
chronic renal failure (CRF) undergoing maintenance hemodialysis ( HD) and to evaluate the
effect of superimposed cardiac functional impairment on the plasma level of this hormone.
Design: A case- series study
Setting: Artificial Kidney and Dialysis Unit of lbn-Sena Teaching Hospital, Mosul; during the
period from June 2003 to August 2004.
Participants: Forty patients with CRF undergoing maintenance HD, were divided into 2 groups depending on presence or absence of heart 6itu[. Group l, includes 20 patients with CRF who did not have heart failure and group Il, includes 20 patients with CRF who had heart failure, The study also includes 20 healthy volunteers as a control group.
Methods: Plasma ANP, serum creatinine, urea and body weights were measured in CRF
patients before and after HD. The same parameters were also measured in the control group.
The paired-t-test was used to examine the difference in the mean of the studied parameters in patients with CRF before and after HD. The unpaired -t- test was used to assess the difference in the mean of the above-mentioned parameters between patients and control group. Pearson correlation coefficient was used to study the relation of the means of differences between pre and post dialysis values of the studied parameters within each patient group.
Results: The mean of plasma ANP level was significantly higher in group I (p<0.0001) and
group ll (p<0.0001) than that in the control group before and after HD. Furthermore, the plasma ANP in group ll was significantly higher (p<0.0001) than that in group I. There was a significant decrease in the plasma ANP in group I (pconclusion: Periodic measurement of plasma ANP level in patients with CRF may be of great
value in evaluating the actual fluid status in patients having CRI and in determination of
frequency and duration of dialysis sessions. lt also may be of value in predicting cardiac
dysfunction in patients with CRF.
Key words: Atrial natriuetic peptide, chronic renal failure, haemodialysis.

objective: To screen women with vaginal discharge for Trichomonas vaginalis as well as other pathogens and to follow them up.Setting: outpatient Gynaecologic Clinic, Family Planning Clinic, and Antenatal Clinic at Al- Batool Teaching Hospital for Gynaecology and Obstetrics. Participants: a 440 women with vaginal discharge (July 1997 to June 1999).Intervention: Full medical, gynaecological, sexual and social history was recorded. Clinical examination was carried out. Laboratory investigations including vaginal, cervical and urethral swabs for direct examination, gram-stained smear, as well as culture on appropriate media.Results: The total number of Trichomonas vaginalis infection was 68 (15.5%). The isolated microorganisms in association with Trichomonas vaginalis were candida albicans in 19 women (27.9%), Staphylococcus epidermidis in 10 women ( 14.7%), and Lactobacilli in six women constituting (8.8 %) . Both Diphtheroids and Neisseria ganorrheae showed lower incidences, as only eight women were positive (5.9 %) for each. Escherichia. Coli was present in one patient (1.5%).24 patients were positive for Trichomonas vaginalis only (35.3 %).The remaining 372 women who were negative Trichomohas vaginalis showed a high rate of infection with Candida species (21.5%),followed by Staphylococcus epictermidis(18.3%) and lactobacilli (15.3%).other isolates included Streptococcus species (8.6%)., E.coli (5.9%), Klebsiella ( 3.8%) ,Enterococcus fecalis (3.0%), Gardnerella vaginalis (2.6%), Neissenria gonorrheae (2.4%), Proteus (2.2), Diphtheroid (1.9%), staphylococcrus aureus(1.3%) and Pseudomonas aeruginosa (0.8%). Moreover, 46 (10.5%) of women showed no growth. 50.0% of infection with Trichomonas vaginalis was at age 26-35 years Considering marital status, the highest rate (76.4 %) of infection was among married women followed by divorced (14.7 %), widows (5.8 %) and singles ( 2.9%). Pregnant women positive for Trichomonas vaginalis represented (45 .6 %) of cases. 61.7% of infection was among illiterate women.Metronidazole (flagyl) was given to all in a dose of 250mg orally thrice daily for seven days.Metronidazole was prescribed at the same time to husbands of infected women. other specific medications (antifungal, antimicrobial agents) were given when indicated either alone or in combination with metronidazole.Two weeks later only 112 women came for reassessment clinically and by repeating direct smear and culture, that showed fifteen positive cases. Five of them still having Trichomonas vaginalis, eight were having Candida albicans, and two showed normal smears. Further courses of treatment were given as indicated.conclusion: Vaginal discharge is common among women in reproductive life.Culture is indicated for precise diagnosisKey words: Trichomonas vaginalis. Vaginal discharge, Metronidazole.

Peripheral neuroepitheliomais a rare malignant tumour of primitive peripheral non autonomic nervous system. The tumour can occur at any age involving soft tissue mainly of lower extremities, Other sites of occurrence are the shoulder-thoracic region and the head and neck.
It is a very aggressive tumour with early metastasis mainly to the lung.
Herewith we report a case of 16 years old female who was presented with soft mass of labia majora of 3 years duration which has been rapidly enlarging in the last 6 months. The mass was excised and followed by administration of chemotherapy and radiotherapy. The patient developed secondaries in the lung 3 months after excision, with pleural effusion, but no local recurrence. However, eight months after the diagnosis and in January 2005, the patient died from the tumour.
Keywords: Peripheral Neuroepithelioma Primitive Neuro Ectodermal Tumour "PNET" Soft tissue.

OHSS is an uncommon, but Potentially life threatening complication of ovarian
stimulation by ovulation induction agents. This condition was first described
as being iatrogenic following the use of gonadotropins in ovulation induction.
White the incidence of iatrogenic OHSS varies between 0.5 - 10 %, it is very rare to
occur spontaneously.