Iraqi Postgraduate Medical Journal

BACKGROUND:
Penetrating injuries of the neck are potentially dangerous, causing high rates of morbidity and
mortality due to their association with sever bleeding and serious damage to the vital structures in the
cervical region.
OBJECTIVE:
To know the incidence and distribution of these injuries on the anatomical zones of the neck and the
damage of the vital structures in the cervical region and their early surgical management.
METHODS:
A prospective study on 52 patients of both civilian and military personnel with penetrating neck
injuries attended the casualty department at Alyarmouk hospital over a period of 7 months from JuneDecember 2006.
RESULTS:
Fifty patients (96.15%) were males. Twenty four patients (46.15%) were in their third decade.
Twenty six patients (50%) were injured by shrapnel of explosives, 23 patients (44.21%) by bullets &
3 patients (5.77%) by unknown objects. Thirty six patients (69.23%) were injured at zone 2, 11
patients (21.15%) at zone 3 & 5 patients (9.62%) at zone 1. Twenty nine patients (55.77%) had
laryngeal & tracheal injuries. Thirteen patients (25%) had pharyngeal & esophageal injuries. Four
patients (7.7%) had recurrent laryngeal nerve injury. Nine patients (17.3%) had vascular injuries 6
arterial & 3 venous. One patient had vertebral & spinal cord injury. Forty one patients (78.86%) had
tracheostomy operations, & 13, (25%) had neck exploration.Six patients (11.54%) treated
conservatively. Nine patients (17.3%) have died.
CONCLUSION:
Male patients at their middle age were the predominant victims either by shrapnel or by bullets. Zone
2 was most commonly affected followed by zone 3 & zone 1. Laryngo – tracheal, pharyngo –
esophageal & vascular structures were mostly involved. Tracheostomy & neck exploration were the
main urgent operations performed for them. The high mortality reflected the serious nature of these
injuries.

BACKGROUND:
Colorectal carcinoma is the most common gastrointestinal tract cancer worldwide. In men, it is the
third cancer after lung and prostate cancer, while in women; it is the third common cancer after lung
and breast cancer. Despite the clear relationship with aging, colorectal carcinoma is not strictly a
disease of elderly and 6-8 % of cases occur in patients below 40 years of age. Colorectal cancers are
of favorable prognosis provided they are diagnosed and treated in early stage.
OBJECTIVE:
This study aims to assess the patterns of presentation, distribution, and management of colorectal
carcinoma in Gastroenterology and Hepatology Teaching Hospital.
METHODS:
From November 2005 to November 2007, 80 patients with colorectal carcinoma 50 males and 30
females were admitted to the Gastroenterology and hepatology center. The age, sex, presentation,
modes of investigation, stage of the cancer, treatments as well as complications have been described.
RESULTS:
Male: female ratio about 1.6:1 with peak age of incidence is 60-69 year age group, 17.5% of cases
are below age of 40 most of them were with worse histopathological types and advanced stage. The
main presenting symptom was bleeding per rectum 63%.The mean period between onset of
presenting symptoms and final diagnosis was 7 months .The most common sites were rectum 35% .
Fiftythree percent were moderately differentiated ,47.5% were Duke's-C.
CONCLUSION:
The study highlights the distribution of colorectal carcinoma, presenting symptoms, modalities of
treatment, keeping in mind the increasing incidence of colorectal carcinoma in younger age groups.

BACKGROUND:
There is a growing attitude towards correcting the nasal deformity in conjunction with primary repair
of cleft lip. Many studies had concluded that this repair will not affect the nasal cartilages growth; it
usually reorients the deformed nasal cartilages into a near normal position, and will allow a better
growth pattern.
OBJECTIVE:
This study was conducted to document the pattern of primary unilateral cleft lip nasal repair and to
evaluate the medium term outcome.
METHODS:
A total of 33 babies with unilateral cleft lip deformities underwent simultaneous nasal correction with
their lip closure, between March of 2004 and April of 2008.Through short nostril rim incision, alar
suspension to the dorsal skin at the nasion and interdomal sutures were performed primarily. Alar
transfixion stitches were used to maintain the new position of the suspended cartilages.
RESULTS:
The average follow up periods were 3 years (ranging from 1 – 5 years).The results were assessed by
4 parameters: Nostril asymmetry, nasal dome projection, alar buckling deformity, and flaring
deformity of the alar base. Eleven patients had good results, 16 patients had acceptable results, and 6
patients had poor results.
CONCLUSION:
Alar suspension is a relatively simple effective procedure for the primary correction of cleft lip nasal
deformity. Short nostril rim incision can be relied on to access the alar dome and facilitate insertion
of suspension sutures. Weather it interferes with nasal growth or not, it is necessary to have a long
period of follow up to answer this question.

BACKGROUND:
Lichtenstein tension free hernioplasty(mesh repair) and Moloney darn repair are commonly practiced
repairs for inguinal hernias with acceptably low recurrence rates. Mesh repair is considered more
recent than darn repair and both of them are tension free.
OBJECTIVE:
To compare the number of postoperative complications and early recurrence between Mesh repair
and Darn repair, for inguinal hernia.
PATIENTS AND METHODS:
The study was conducted at Department of Surgery, Al-Sadur teaching hospital in An-Najaf from 1st
august 2007 to 1st august 2008 . A total of 104 patients were selected. 51 patients were treated with
Lichtenstein tension free hernioplasty (Group A) and 53 with Darn repair (Group B). Cases were
followed up for three months to one year. The study design was quasi experimental.
RESULT:
The male to female ratio was 51:1. The mean hospital stay was 37.18 hours in group A and 47.17
hours in group B. there was statistically significant difference between the groups ( p< 0.05).
The mean operative time was 44.7 minutes in group A and 50.9 minutes in group B. There was
statistically significant difference between the groups ( p< 0.05). the The total number of
postoperative complications was reported in 36 patients, 15 ( 29.42%) complications occurring in
group A and 21( 39.62%) in group B. Scrotal swelling was the most common complication followed
by urinary retention and wound infection in both study groups. Postoperative complications like
scrotal swelling ( 11.77% vs. 16.98%), haematoma ( 5.88% vs. 3.77%), urinary retention (5.88% vs.
9.43%), wound infection ( 1.96 vs. 7.55%) and scar pain ( 3.92% vs. 1.89%) were unsignificantly
low in Lichtenstein tension free hernioplasty as compared to Darn repair (P > 0.05). There were no
recurrences noted till date in any of the two groups under study.
CONCLUSION
Open inguinal hernia repair with a nylon darn was equivalent to polypropylene mesh with respect to
early measures of postoperative outcome and recurrence at 1 year. The mesh was superior to darn in
operative time and hospital stay.

BACKGROUND :
Controversy persist regarding the treatment of pilonidal sinus. Sacrococcygeal pilonidal disease is
a common chronic disorder of the natal cleft that is often considered a minor problem, but may
cause substantial in convenience and local infection. Therefore, adequate treatment of a pilonidal
sinus is important in order to improve the quality of life of affected patients.
OBJECTIVE:
To evaluate the technique of excision with primary suture and suction drainage (PSD) for the
treatment of pilonidal sinus in adolescent patients.
METHODS:
Between 1996 and 2005, forty patients aged 14-19 years (are range 16.4) underwent PS excision
with primary closure and suction drainage. Anesthesia was general in 18 (45%) and spinal in 22
(55%). Prophylactic cephalosporine was used is I.V antibiotic. Excision of the sinus done down to
the social fascia. Closed continuous suction drain was used.
RESULT:
No complications due to the anesthesia were observed. Twenty five patients (62.5%) had day case
surgery, while the others fifteen patients, (37.5%) were hospitalized for 2-4 days (average 2.3
days). The drain was removed on post operative day 3-6 days (average 3.2 days) primary healing
with no postoperative complications occurred in 36 patients (90%). Postoperative infections
requiring incision , drainage, and lay-open occurred in 3 cases (7.5%). No recurrence was found at
12-months follow-up. One recurrence (2.5%) was noted 2 years after surgery.
CONCLUSION:
Excision with primary closure and closed-suction drainage as an ambulatory procedure is thus a
simple and effective method of treatment of uncomplicated PS in adolescents.

BACKGROUND:
With the use of diagnostic laparoscopy widely accepted in the setting of the non palpable testes,
now day's laparoscopic orchidopexy is an efficient and logical alternative to open orchidopexy.
OBJECTIVE:
We reviewed the efficacy of laparoscopy for diagnosing the intra abdominal testes.
Also we review the efficacy of primary orchidopexy, one stage and two stages laparoscopic
orchidopexy for the management of the intra abdominal testes.
PATIENTS AND METHODS:
Prospective Study includes 20 boys with 23 impalpable testes (3 patients were bilateral). underwent
laparoscopy for a non palpable testes at urosurgical department between June 2007 and February
2009.
Their age ranged between 3years and 7 years. Eight patients had primary laparoscopic orchidopaxy
without division of spermatic vessels .twelve patients had one stage Fowler Stephen method, and
Two patients had two stages Fowler Stephen method.
RESULTS:
During diagnostic laparoscopy: Bilateral abdominal testes was found in 3 patients, Left intra
abdominal tests was found in 10 patients, while right intra abdominal testes was found in 7
patients .With the use of laparoscopic orchidopexy : twenty two testes were brought down to the
scrotum: sixteen testes (72.7%) brought down to the normal scrotal site, while six testes (27.2 %)
were placed at high scrotal position. Orchidectomy was done for one (4.3%) intra abdominal testis.
CONCLUSION:
Laparoscopy is extremely effective for diagnosis and treatment of patients with non palpable testes.
Laparoscopic orchidopexy is the logic extension of diagnostic laparoscopy for intra abdominal
testes.

BACKGROUND:
Profound hemodynamic alterations occur during pregnancy, labour and in the postpartum period. These
changes can adversely affect both maternal and fetal outcome, if a women encounter a valvular heart
disease during her pregnancy.
OBJECTIVE:
We try to evaluate the effect of valvular heart disease on maternal and fetal outcome of pregnancy.
METHODS:
This is a cross section descriptive study, carried out in Baghdad teaching hospital, throughout the period
from September 2007 to October 2008. Seventy eight pregnant women with valvular heart diseases, in
labour, were enrolled in this study. Their medical and obstetrical records were reviewed on admission. We
looked for maternal outcome after delivery (method of delivery, heart failure, arrhythmia, need for
medication and period of hospitalization), additional to fetal outcome (prematurity, viability and birth
weight).
RESULTS:
Mitral valve disease is predominate valvular heart disease in pregnancy, most of them of mild severity. All
maternal and fetal outcome parameters adversely increase among pregnant women with valvular heart
diseases.
CONCLUSION:
Valvular heart diseases carried a higher risk for both mother and fetus. The risk related directly to severity
of valvular heart diseases.

BACKGROUND:
Missed abortion refers to a pregnancy that can manifest as an anembryonic gestation or fetal
demise prior to 20 weeks' gestation. Medical management has been used as a treatment options.A
common medical regimen used to evacuate the uterus is vaginal misoprostol (Cytotec) in single or
multiple doses.
OBJECTIVE:
To compare the therapeutic efficacy and adverse effects of intravaginal administration of a nitric
oxide donor (glyceryl trinitrate) with that of a prostaglandin (misoprostol) to induce cervical
changes in women with missed miscarriages to terminate their pregnancies.
METHODS:
A prospective, randomized comparative trial conducted at Al-Yarmouk Teaching Hospital,
Department of Obstetrics & Gynaecology/ Baghdad-Iraq, enrolled Sixty women with first trimester
missed miscarriages that requested pregnancy termination. They were randomly selected to receive
either two tablets of 500 µg glyceryl trinitrate vaginally (n = 30) or 200 µg misoprostol tablet
vaginally (n = 30), every 3 hours to a maximum of four doses or until reaching desirable cervical
changes. Baseline vital signs were recorded and repeated with monitoring for adverse side effects
every 3 hours until finishing therapy.
RESULT:
The difference in cervical changes between the two groups was statistically not significant (p >
0.05). The successful outcome taken as cervical dilatation ≥ 10 mm, incomplete, or complete
miscarriage was achieved in 30% of women in the glyceryl trinitrate and in 53% of women in the
misoprostol group which was statistically not significant ( p>0.05).
Systolic & diastolic blood pressure, temperature & heart rate were lower with glyceryl trinitrate
than misoprostol, but the differences were not significant (p>0.05).The most frequent side effect
associated with glyceryl trinitrate administration was headache, which occurred in 27/30 women,
compared with only 5/30 women in misoprostol group; relative risk 5.42 (p <0.05). Women
treated with misoprostol reported mainly lower abdominal pain; relative risk 4.2 (p <0.05).
CONCLUSION:
Although glyceryl trinitrate was less effective than misoprostol when used prior to termination of
missed miscarriage, the difference was statistically not significant. Moreover glyceryl trinitrate
caused less adverse effects than misoprostol and it could have a role in the management of this
obstetrical problem.

BACKGROUND:
Elevated count of nucleated red blood cells (n-RBCs) in the cord blood of fetuses at birth as well as
prolongation of pregnancy, have been suggested as predictor of adverse perinatal outcome.
OBJECTIVE:
A prospective cohort study to evaluate the association between umbilical cord nucleated RBCs (ucnRBC) count in uncomplicated overdue pregnancies with their neonatal outcome.
PATIENTS & METHODS:
One hundred and eighty five ladies with overdue pregnancy (41 -42 weeks+3days) were included in the
study. Dating was confirmed by their precisely recalled last menstrual periods and early pregnancy
sonographies. At their deliveries, umbilical cord nucleated red blood cells were counted and expressed
per 100 white blood cells. Mode of delivery, the newborn outcome and the risk factors were all analyzed
with the obtained counts of the n-RBCs using descriptive and inferential statistics.
RESULT:
The number of n-RBCs counted, ranged from 3-43/ 100 WBC and accordingly the cases were
categorized into 3 groups. Those with more than 20 n-RBC/100 WBC (high risk group) showed higher
incidence of neonatal risk outcomes (49.3% of the calculated total risks) than the group with 3 -10 nRBC (low risk group) which included about half of the participants, it exhibited only 20.5% of the total
risks. The risk outcomes include; meconium staining, admission to neonatal intensive care unit, neonatal
death and Apgar score at 7 minutes less than 5. Moreover, cesarean section rate in high risk group was
almost double its rate in the low risk group (44.7% Vs 22.5%).The association between risk outcome
and n-RBC counts is statistically highly significant P value < 0.001.
CONCLUSION:
In overdue pregnancy, umbilical cord n-RBC count of the new born is significantly associated with risk
outcome.

BACKGROUND:
Host genetic factors such as human leukocyte antigens (HLA) and non-HLA genes that are associated
with the susceptibility to tuberculosis (TB) will serve as genetic markers to predispose or predetermine
the development of the disease.
OBJECTIVE:
The aim of this study is to analyze the association between particular HLA-typing class I and the
incidence of pulmonary tuberculosis in Baghdad city.
PATIENTS & METHODS:
Blood samples were collected from one hundred patients; 50 samples from patients with pulmonary
tuberculosis referred to the Chest and Respiratory Diseases Institute in Baghdad city and 50 samples from
apparently healthy individuals. All samples were submitted to the lymphocytotoxicity test (NIH) and
examined in Major Histocompatibility Laboratory in AL- Karama Hospital in Baghdad city.
RESULT:
It was found that HLA (15) expression was significantly higher in recently infected patients with
tuberculosis than in the controls (p<0.01) and HLA-A (33) was significantly lower in those patients than
the controls (p<0.05). HLA-A (1) was high significantly lower in historical TB patients than the controls
(p<0.01). HLA-B (17) was significantly higher in recently infected patients with TB than the controls
(p<0.05), HLA-B(35) was high significantly lower in historical TB patients than the controls (P<0.01).
This study concluded that frequencies of HLA-A (15), HLA-B (17), in recently diagnosed pulmonary TB
patients were significantly increased compared with those in the control group.
CONCLUSION:
The development of pulmonary tuberculosis infection is partly controlled by genetic factors. Sophisticated
techniques such as (PCR) are needed for more assurance to verify this association. Further studies are
required to investigate a possible relation between HLA-typing class II and the incidence of pulmonary
tuberculosis in Iraq.

BACKGROUND:
Pancreatic masses are often initially identified by magnetic resonance imaging or computed
tomography, during evaluation of varied symptoms. Endoscopic ultrasound (EUS)-guided fineneedle aspiration (FNA) has been proved to be safe and useful method for tissue sampling including
the pancrease.
OBJECTIVE:
In this study we aim to find out some of the factors which may influence successful EUS-FNA of
pancreatic masses, like: location of the mass, size, consistency and other significant factors.
PATIENTS AND METHODS:
A retrospective study of 40 patients underwent EUS-FNA of pancreatic masses, referred to
Gastroenterology and Hepatology Teaching Hospital in Baghdad, from March 2005 to December
2007 (this is the first study done in Iraq); all patients were clinically suspected to have pancreatic
malignancy. Cytology samples were evaluated and many other clinical variables were examined for
association with EUS-FNA diagnosis.
RESULT:
Twenty six (65%) patients were males, and 14(35%) patients were females. Age ranged between 13-
65 years with a mean of 46.6 years, the size of pancreatic masses range between 1.7-13cm, the
masses were divided into 3 groups according to their sizes: <5cm 26(65%) cases, between 5-10cm
13(32.5%) cases, and >10 cm 1(2.5%) case. Consistency wise the masses were characterized as solid
34(85%) cases, mixed solid and cystic 6(14%) cases. In 13(32.5%) cases the mass was located in the
body of pancrease, 25(62.5%) cases in the head, and 2(5%) cases in the tail. Regarding the
cytological diagnosis: 19(47.5%) cases were benign (inflammatory conditions), and 21(52.5%) cases
were malignant; including 17(80.9%) cases adenocarcinoma, 2(9.5%) cases malignant mucinous
tumor, and small cell carcinoma 1(4.8%)case, and papillary and solid epithelial neoplasm (solid
pseudopapillary tumor SPPT) 1(4.8%)case. Lymph node enlargement was found in 10(25%) cases.
CONCLUSION:
EUS-FNA can be used to sample pancreatic tumors in most patients. Communication clinical
background information and imaging findings to the cytopathologist can facilitate the interpretation
of the FNA specimens.

BACKGROUND:
3-hydroxy-3methyl glutaryl co enzyme inhibitor (MMG-COA) (statin) is a very common drug used
in many medical conditions regardless of the presence or absence of dyslipidemia. One of these
conditions is the cardiac disorders.
OBJECTIVE:
Throwing a light on the prevalence of their side effects in Iraqi patients.
PATIENTS AND METHODS:
Two hundred seventy patients with ischemic heart disease from the period of November 2006-
November 2007 referred to Baghdad teaching hospital (the medical city). Those cases were using
statin and grouped into two groups.
Group A: patients admitted with acute coronary syndrome (myocardial infarction and unstable
angina) (230 patients 77%).
Group B: patients with associated risk factors (Hypertension, diabetes mellitus, smoking and
secondary lipidemia) 40 cases 23%, have history of ischemic heart disease on treatment they use the
drug in range of (10-40) daily with review monthly for the side effects. All 270 cases were free from
other organic disorders (i.e. renal, thyroid, malignancy, or any longstanding disease). All patients
went through a questionnaire which includes: age, gender, risk factors (Hypertension, diabetes
mellitus, smoking, and lipidemia), routine blood tests, lipid profile, liver function tests, C-reactive
proteins, thyroid function tests, chest X-ray, electrocardiography and echocardiography done for all
patients, all patients used to take drugs in the range of 10-40mg daily for at least one year.
RESULT:
The side effects noticed in this study were gastric, musculoskeletal, elevated liver enzymes (40%,
28.9%, and 1% respectively from the total number of patients). Other side effects in other systems
like skin, respiratory, and cardiac were not encountered.
CONCLUSION:
This study showed that the side effects of statin were not involving all the body systems.

BACKGROUND:
The study objectives are to identify the problems which confront renal transplant recipients ( RTRS).
OBJECTIVE:
Identify the physiological problems which confront renal transplant recipients ( RTRS).
METHODS:
A descriptive study was carried out at two Teaching Hospitals with kidney transplant centers.
Surgical specialties and Al-Karama outpatients, clinics for ( RTRS) , and three Teaching Hospitals;
Medical city, Al-Karama and Al-Yermok which were responsible for immunosuppressive drugs
distribution .Starting from October ,1 st 2006 to the end of July 2007.To achieve the objectives of
study, a non-probability (purposive) sample of 150 ( RTRS) who were attending to the outpatient
clinic of the above listed hospital were selected according to the criteria of the study sample .
The finalized questionnaire contained (42) items. The content validity of the instrument was
established through penal of (14) experts. Reliability of the problems scales was determined by testretest method which was estimated as average (r=0.76).
Data was gathered by interview technique using the questionnaire format and data was analyzed by
application of descriptive and inferential statistical methods.
RESULT:
The results of the study indicated that the ( RTRS) confront (83 ) problems and affected by these
problems with different severity level, high, moderate, and low.
CONCLUSION:
according to the results of this study, the researcher recommended that the provision of the necessary
post transplant medicines should be easily acquired from easy to reach centers.

BACKGROUND:
Dyspepsia is a common symptom in general practitioner. Using non invasive serological biomarkers
would help to identify individuals at increased risk of atrophic gastritis and gastric cancer. In present
study, the evaluation of the utility of a serological gastric panel test combining pepsinogen I (PGI),
pepsinogen II (PGII), pepsinogenI/ pepsinogenII ratio (I/II), gastrin-17 (G-17) (basal and stimulated)
and Helicobacter pylori (HP) IgG antibodies as a screening method and to predict the state of gastric
mucosa: non atrophic, atrophic gastritis and its sequel of developing gastric carcinoma and intestinal
metaplasia.
OBJECTIVE:
Prediction of gastric mucosa using non invasive immunological blood tests from dyspeptic patients.
PATIENTS AND METHODS:
The serological gastro panel test was evaluated in (54) Iraqi dyspeptic patients divided into two
groups: (HP +) and (HP-). Levels of PGI, PGII, PGI/PGII ratio, G-17 basal and stimulated and HP
IgG antibodies were determined through a specific immunological non invasive Enzyme Linked
Immuno Sorbent Assay (ELISA) test from Biohit PIC, Helsinki, Finland. Using fasting and
postprandial samples from those patients.
RESULTS:
60% of dyspeptic patients complain from epigastric pain and 62.96% of them had HP +.There were
significant increase in PGI, PGII (p<0.05) in NAG .In case of I/II ratio, there was no significant
difference between two groups of HP+ and HP-.The other parameter was done is basal G-17 which is
significantly increased in HP+ (p>0.05) and postprandial G-17 showed no significant difference
between two groups.
CONCLUSION:
Most of those Iraqi dyspeptic patients had non atrophic gastritis due to Helicobacter pylori infection
that leads to increased in the PGI, PGII, G-17 through many mechanisms. If HP not treated properly
this may leads to atrophic gastritis , peptic ulcer and gastric carcinoma. Gastric panel test was
considered as a non endoscope immunological blood test in the diagnosis of atrophic gastritis and its
outcome in dyspeptic patients.

BACKGROUND:
Infantile kala-azar is an endemic protozoal disease prevalent among children in Iraq. A rapid
diagnostic laboratory tests are required for immediate treatment.
OBJECTIVE:
A prospective study was conducted in two pediatric hospitals in Baghdad during the period from Oct.
2005 to Sept. 2006 to evaluate the efficiency of immunochromatography strip test (IC) with rK39
antigen compared to indirect fluorescent antibody test (IFAT) for serodiagnosis of visceral
leishmaniasis (VL) to investigate its use for epidemiological studies in Iraqi kala-azar.
PATIENTSAND METHODS:
The study included 54 proved cases for Leishmania donovani (L.D.) bodies in bone marrow, 108
clinically diagnosed cases, 38 with diseases other than VL (tuberculosis, acute amoebic dysentery,
urinary schistosomiasis, brucellosis, toxoplasmosis and malaria) and 24 healthy controls. In addition
of 3000 patients presented with fever, anaemia and hepatosplenomegaly.
RESULT:
The highest sensitivity of the sera was obtained by IC (92.6%) and by IFAT (96.3%), and the highest
specificity by IC (100%) and by IFAT (86.8%). In the epidemiological study with rK39 strip test
66.1% positive reactions were obtained in patients with fever, anaemia and hepatosplenomegaly.
CONCLUSION:
IC strip test with rK39 antigen was more easy to perform but less sensitive than IFAT and the former
was more specific than the latter.

BACKGROUND:
Most patients with steroid sensitive nephrotic syndrome (SSNS) have frequent relapses until disease
resolve spontaneously toward the end of second decade of life and so the main problem in such
disease is frequent relapses and their association with complications of disease or side effects of
drugs used in each relapse.
OBJECTIVE:
In this study, we evaluate different factors which might be associating or leading to occurrence of
frequent relapses.
PATIENTS AND METHODS:
A retrospective study was done in the Central Child Teaching Hospital from Feb. 2007 - Feb. 2008,
during this period, 120 patients with nephrotic syndrome (NS) randomly selected who were
diagnosed & or treated in this hospital. Out of 120 patients, 85 (70.8%) patients with steroid sensitive
nephrotic syndrome (SSNS), 9 (7.5%) patients with steroid dependant nephrotic syndrome (SDNS)
and 26 (21.7%) patients with steroid resistant nephrotic syndrome (SRNS). The steroid sensitive
patients were divided into 24 (28.2%) patients as undetermined (UD) group, 35 (41.2%) patients with
frequent relapses (FR) group and 26 (30.5%) patients with infrequent relapses (IFR) group. We
compare between frequent and infrequent groups regarding to age, sex, type of presentation,
biochemical finding, precipitating factors, family history of renal disease, the time needed to
responsd to steroid therapy and duration of steroid therapy.
RESULTS:
The age ranged from 1-16 years, with peak incidence at age group from 1-5 years. There were 64
patients (53.3%) presented with this age group, most of them were steroid sensitive nephrotic
syndrome 53 (82.5%) patients. There were 73 male and 47 female & M: F ratio 1.5: 1, most of them
(70.8%) with steroid sensitive nephrotic syndrome & male to female ratio was 1.8: 1. The main type
of presentation was preiorbital oedema; the main type of precipitating factor was respiratory tract
infection. The family history of renal disease (P value = 0.0006) and the delay in response to steroid
therapy, 2 weeks and more (P value = 0.0477 & 0.0486) were statistically significant correlation with
frequent relapsers (FR) group in comparison to infrequent (IFR) group.
There were no statistically significant differences between frequent and infrequent groups regarding
other factors.
CONCLUSION:
There were significant correlation between family history of renal disease & delay in response to
steroid therapy with occurrence of frequent relapses supporting other studies but this study fails to
confirm previous studies about other factors.

BACKGROUND:
Ventral Penile Papillae (VPP) are benign asymptomatic structures that are found on the skin of the
ventral aspect of penile shaft of many adult males; yet, no frank record or description of them is found in
the English medical literatures.
OBJECTIVE:
To hit light on the VPP, finds their frequency among circumcised Iraqi adult males, seeks about their
associations with other skin conditions, and examines the histological picture.
PATIENTS AND METHODS:
Forty seven Iraqi circumcised adult males were included in this case descriptive ,comparative study
which extended between July 2007-November 2007 was conducted in Department of DermatologyBaghdad Teaching Hospital. All 47 persons were asked about sociodemographic aspects, medical and
skin conditions. They were evaluated clinically regarding different clinical aspects. Statistical data were
deduced. Biopsies were done for 8 papillae from 6 persons for histological assessment. Also, 50
circumcised children under the age of 10 years were examined for the presence of these papillae as a
control group.
RESULT:
Forty seven males were enrolled the present work, their ages ranged from 14-59(29.72+10.57) years.
Twenty five (53.2%) persons had VPP, while 22 (46.8%) subjects showed no papillae. Fifty circumcised
children of ages ranged from 3.5-10(5.97+1.42) years, all were lacking the papillae. The papillae were
asymptomatic. Shapes of papillae were distributed as follows: skin tag-like papillae were 53.93%, domeshaped 40.44%, while wartlike in 5.61% of these papillae. Histology was normal apart from finding of
dermal encapsulated structures which simulate mechanoreceptor nerve endings, so called Meissner’s
corpuscles.
CONCLUSION:
All facts start as speculative thoughts as had been proved by the present study. Ventral penile papillae are
normal anatomical and physiological structures that are present in only adult males while completely
absent in children. So the age of onset lies during adulthood. The location, morphology, age of onset, and
the histology of these papillae are very suggestive of their sexual stimulatory function. Still further
physiological and histological studies are strongly recommended.

BACKGROUND:
This prospective study was done in spiral CT units at Al-Yarmook teaching hospital & Al-Kadhmia
teaching hospital , in the period from October 2005 to October 2007, 40 Patients with renal masses
were examined
OBJECTIVE:
To evaluate the role of spiral CT in the diagnosis of renal mass lesion. Agreement between spiral CT
with histopathology in diagnosis of renal masses by spiral computed tomography.
PATIENTS & METHODS :
Forty patients with renal masses were referred to spiral CT examination , they were referred from
urology department . The final diagnosis of most cases was confirmed by surgery and histopathology
in (36) cases. The patients ages ranged from (3-79) years. Data collection regarding age, sex,
occupation, history of cigarette smoking, history of renal stones, clinical presentation, past history,
family history of renal disease, history of trauma and previous history of hospital admission were
made.
RESULTS:
The most common age group affected was (50-59) most frequently Presenting symptom was
haematuria .
The sensitivity 76.9%, specifity 97%, PPV 78%, NPV 96.4% and accuracy of CT in diagnosis of
renal masses was 96%.
CONCLUSION:
This study shows that CT is highly specific and accurate for diagnosis of renal masses and especially
the renal cell carcinoma,which is the most common tumor detected in this study.