Iraqi Postgraduate Medical Journal

ABSTRACT:
OBJECTIVE:
The aim of the study is to evaluate the role of both the flexible and the rigid bronchoscopy in the diagnosis of
carcinoma of the lung according to our present experience.
METHODS:
192 cases of carcinoma of the lung in whom diagnosis was established histopathologically or cytologically
and for whom bronchoscopy, rigid or flexible was performed to establish diagnosis or to assess
operability, have been studied.
RESULTS:
Out of the 104 patients examined by flexible bronchoscopy, histopathological or cytological diagnosis was
established in 72 patients (69.23%). Intrabroncheal tumor was visualized in 52 patients (50%). Biopsy was
taken in 49 out of these 52 patients and was positive in 43 patients (87.75%).
Out of the 88 patients examined with rigid bronchoscopy histopathological or cytological diagnosis was
established in 62 patients (70.45%). Intrabroncheal tumor was visualized in 40 patients (45.45%). Biopsy
was taken in all these 40 patients and it was positive in 39 patients (97.5%).
CONCLUSION:
The study showed that the two modalities of bronchoscopy were safe and almost with the same diagnostic
capability, with the flexible bronchoscopy having more extended scope of vision while the rigid one
having better and more accurate biopsies.

BACKGROUND:
Stromal or mesenchymal neoplasms affecting the gastrointestinal (GI) tract are divided into two groups. The
less common variety includes tumors that are identical to those that arise in the soft tissues throughout the
rest of the body, including lipomas, schwannomas, hemangiomas. The second more common group consists
of stromal tumors that are collectively referred to as gastrointestinal stromal tumors (GISTs).
They are most often located in the stomach and proximal small intestine.
OBJECTIVE:
To compare the incidence, mode of presentation and management of malignant gastric GISTs of this study
from Iraq with other world reports.
METHODS:
Retrospective study of the medical records of 1037 patients with gastric malignancies operated upon
between January 1970-December 2000 were reviewed. The incidence of GISTs , their age and sex,
symptomatology, diagnostic procedures, surgical management and results will be presented.
RESULTS:
Among 1037 patients with gastric malignancies, 13 (1.25%) were malignant GISTs. 6 were males and 7
females. Age ranges from 19-67 (median 58 +/- 13 .2397 SD) years. Mode of presentation were; upper GI
bleeding 8(62%), dyspepsia 4(31%) and mass one (8%) patient. Duration of illness ranges from 2 days-8
years (median 3 months
+/- 25.9207 SD ). Barium study revealed a tumor in 10 out of 11 patients. Endoscopy in 12 patients reported
4 nodular, 3 fungating and 3 ulcerative tumor and two normal. Ultrasound in 8 patients showed a mass in
7(5 intraluminal, two extraluminal) and no tumor in one. Site of tumor were the; lesser curve 4(31%),
antrum 3(23%), greater curve 2(15%), fundus 2(15%), body one (8%) and cardia one (8%) patient. Grossly
the tumors were; fungating 5, nodular 2, ulcerative one, nodular-cystic 3 and nodular-ulcerative in 2. The
tumor size vary from 5x3 – 17x12 (mean 9.69231 +/- 3.727793 SD x 7.69231 +/- 2.95479 SD) cm.
Gastric resections were; upper 5, segmental 4, subtotal 2 and lower 2 patients. Chemotherapy and/or
radiotherapy were given to advance or those with metastasis. Histopathology reported low-grade
malignancy in 5 and high-grade in 8 patients. According unified 1997 TNM staging were; I 2, II 4, III 3 and
IV 4 cases. Two-years survival was 69% (9 out of 13) and 5-years was 46% (6 out of 13).
CONCLUSION:
Malignant GISTs constitute 1.25 % of all gastric malignancies. No gender predilection found. Median age
50.3 years. Recurrent upper GI bleeding in 62% and dyspepsia in 31%. No specific symptoms but
abdominal mass in 4 cases. Barium study, endoscopy and US were the diagnostic procedures. Tumors were;
mostly intraluminal, fungating nodular and large (median 8x8 cm). Resection was the treatment. 5 were
low-grade and 8 high-grade malignancy. 2 and 5-years survival were 62% and 46% respectively.

BACK GROUND:
Compound comminuted fractures around elbow are one of the most common injuries in our
country today due to high velocity missile injuries they present a great challenge to the orthopaedic
surgeon and severe suffering to the patients as comminution makes anatomical reduction
impossible and stiffness is a well known associate .This study was designed to evaluate the
functional outcome for such injuries.
OBJECTIVE:
To evaluate the functional results of management of compound fractures in and around elbow joint
using across elbow external fixation and early physiotherapy.
METHODS:
A case series study was designed, a (20) patients presented to the orthopaedic and trauma
department in the Medical City / Surgical Specialties teaching Hospital / Baghdad/ during the last
two years 2006-2007 , with history of high velocity missile injury to their elbow or around it, all of
them treated by early wound excision and application of across elbow external fixation followed up
for 6 weeks till healing of their wounds then the external fixation was removed and active assisted
movement were started, patients followed up for 6 months and assessed both clinically and
radiographically.
RESULTS:
Good range of elbow movement and return to the original work of the patients were noted in 100%
of the patients, and follow up for the first 6 weeks after removal of the external fixation shows that
most of the patients (15) got functional range of elbow movement, According to Mayo elbow
performance score nine patient got 95 points and eleven got 85 points.
CONCLUSION:
Functional range of elbow movement can be achieved in compound comminuted fractures in and
around elbow by using external fixation across the joint then physiotherapy.

BACK GROUND:
Pain after abdominal incisions is responsible for many postoperative problems, especially
pulmonary and thromboembolic complications. Although many analgesic drugs are available yet
they have to be given systemically to be effective with a real danger of respiratory depression.
The use of local anesthetic drug infiltrated in the wound at the end of surgery is a logical solution
.The aim of this study is to evaluate the effect of local anesthesia in the control of postoperative
pain
METHODS:
During the period January 2007 until December 2007 hundred and twelve patients had abdominal
operations at Baghdad Teaching hospital .Patients were randomly allocated to two groups .Group
(1) included 56 patients who had 10 ml bupivacaine infiltrated in the wound by a sub facial
catheter before wound closure and Group (2) 56 patients had placebo injected (2 ml of normal
saline).Visual analogue scale was used for post operative pain assessment
RESULTS:
There was a significant decrease in pain score and the requirement of the systemic analgesic in
Group (1) during the 1 st 24h after surgery as compared to Group (2) with (P. < 0.05) .The type of
surgery which showed marked decrease in pain score were repair of hernia, open cholecystectomy
and appendesectomy and was least obvious after midline incision.
CONCLUSION:
There was a significant decrease in pain intensity and the analgesic requirement in patients who
had local wound infiltration with bupivacaine as compared to placebo group thus making it an
effective, simple and cheap method in relieving pain after abdominal incisions.

BACKGROUND:
Bowel obstructions are not uncommon should be suspected in any patient with persistent vomiting,
distention, and abdominal pain because delayed diagnosis and treatment can have devastating
consequences. Undiagnosed or improperly managed obstructions can lead to vascular compromise,
which causes bowel ischemia, necrosis, perforation, sepsis, and death.
OBJECTIVE:
The object of this study is to focus attention on the causes of intestinal obstruction and the role of
abdominal radiographs and imaging in the diagnosis and operative procedures undertaken.
Setting: The study was conducted at the Department of Surgery, Erbil Teaching Hospital Erbil
province (2.5 million populations) –Iraq, between years 1996 and 2005 inclusive.
METHODS:
A prospective study was carried out spread over 10-years, and involving 591 patients with intestinal
obstruction, among them only 570 patients underwent operations included in this study and 21
patients with conservative management had been excluded.
Of the 570 patients with intestinal obstruction, 411were male patients (72.1%) their mean ages were
51.25% and 159 were female patients (27.9%) their mean ages was 39.8%.
RESULTS:
The most common cause was the entrapment of bowel in an external hernia (30.7%). Postoperative
adhesions accounted for obstruction in a third of our patients (28.7%), and (59%) of them followed
appendectomy. The operative findings of all patients who presented obstructed hernias still account
for the highest percentage of cases. Other minor causes constitute the rest of cases.
All 570 patients with the diagnosis of IO underwent surgical procedures in 68 patients (11.9%)who
developed serious complications in the form of Sepsis, Intra-abdominal abscess, Wound dehiscence,
Aspiration, Short-bowel syndrome (as a result of multiple surgeries)
Forty patients died (7%) mostly because of irreversible shock, pulmonary embolism, and multiorgan
failure .
CONCLUSION:
entrapment of bowel in an external hernia and adhesions remain the leading causes of acute intestinal
obstruction in our environment. Sustained efforts at elective repair of hernias and research aimed at
reducing adhesions are likely ways to reduce the high mortality from intestinal obstruction.

BACKGROUND:
Management of acute appendicitis is strictly surgical but acute appendicitis presented as appendix
mass could be treated in different ways including using antibiotic treatment regime but these options
remains controversial. The aim of this study was to evaluate the role of antibiotic in the conservative
management of appendix mass.
METHODS:
The medical records of 1051 patients diagnosed as acute appendicitis at two different teaching
hospitals in in Yemen, have been reviewed for the purpose of this study. 516 cases collected from
Kuwait University Hospital,(K.U.H.) Sanu'a (between Jan 2005 to Dec 2007 ) and 535 cases collected
from Ibn Sina Teaching Hospital ,(ISTH). Mukalla, (between Jan 2007 to Dec 2007). It has been found
that 893 cases had urgent operation, and 98 patients diagnosed as suspected non obstructive acute
appendicitis and got recovered completely with conservative treatment. On the other hand 60 cases,
(5.7%), presented with appendix mass, and have been treated conservatively by distributing them
randomly into two selected groups, group A treated with rest + antibiotic, group B treated with rest
only and results analyzed prospectively
RESULTS:
The 35 appendix mass cases treated at K.U.H, represent (7.5%) ,cases distributed as Group A, had an
average hospital stay of Sdays ( ranging from3-7), while group B, had stayed an average of 6.5 days
(ranging from3-ll). 25 appendix, mass cases
represent 5.1% at I.S.T.H. Group A. had an average hospital stay of 5.5 days(3-8) ,while group B, had
an average of 8 days (3-20). the proportion of appendix mass presented with pyrexia in both groups
were 41.6%.
Complications: two cases reported at I.S.T.H with signs &symptoms of recurrent sub acute
appendicitis and palpable residual appendix mass, both from group A, refused operation and were
treated conservatively with the same regime (antibiotics+ rest) signs and symptoms subsided in few
days & discharged. Other complications such as abscess formation or spreading peritonitis were
absent.
Interval appendicectomy; all patients were advised to come back in 6 weeks for elective
appendicectomy. 6 cases reported at K.U.H, and only 2 at I.S.T.H. All were free from signs &
symptoms and they had operation
CONCLUSION:
Conservative treatment for appendix mass is effective and safe, antibiotic, might shorten the
resolution time but not essential. Complications is only 3% and represented by recurrent sub acute
appendicitis, which responded to conservative treatment. Interval appendicectomy is probably
unnecessary and should be reserved for cases with recurrent of signs and symptoms only

BACKGROUND:
Xeroderma pigmentosa although it is autosomal recessive disease but it is not uncommon problem in
a certain regions in Iraq. It is always associated with well known complications of the disease like
malignancies and blindness. Zinc sulfate has been successfully used in treatment of basal cell
carcinoma in a form of intralesional injection & topical solution.
OBJECTIVE:
To evaluate the effectiveness of topical 20% zinc sulfate solution as a therapeutic and prophylactic
agent in patients with xeroderma pigmentosa.
METHODS:
This single blind therapeutic trial was done in the Department of Dermatology & VenereologyBaghdad Teaching Hospital during the period from April 2004 to April 2005. Nineteen patients with
typical features of xeroderma pigmentosa enrolled in this work. Full history and clinical examination
were done for each patient regarding all points related to the disease. They were treated with topical
20% topical zinc sulfate solution and follow up was carried out for 4 months to 2 years.
RESULTS:
Nineteen patients with xeroderma pigmentosa were evaluated after treated with 20% topical zinc
sulfate solution. Four patients were defaulted during follow up for unknown reason. The remaining
were 15 patients (11 males and 4 females). Their ages ranged from 4-50 years with a mean± SD of 18
±17 years. Monthly follow up showed improvement in all types of skin lesions including softening
and lightening of the skin color, and clearance of solar keratosis and small malignancies. These were
observed in the early course of therapy.
CONCLUSION:
This study showed that topical therapy with zinc sulfate solution had both therapeutic and
prophylactic role in patients with xeroderma pigmentosa .We think that zinc sulfate is going to have a
major role in management of this disease.

OBJECTIVE:
The aim of the study is to find the types of aerobic bacteria in diabetic foot infection in iraqi patients.
METHODS:
(100) Patients with infected foot, 69 male, 31 female with mean age (45) years, attends the diabetic
foot clinic at the special center for endocrinology and diabetes for the period( August 2000 to
February 2002).
Clinical examination and foot evaluation for infection was done for all patients and swab was taken
for culture and sensitivity study.
All data were documented in special computer form for analysis and study.
RESULT:
Male affected more than female. Type two DM (diabetes mellitus) is more susceptible for foot
infection than type one DM. polymicrobial infection is commoner than single type bacterial infection.
Gram negative bacteria are more common than gram positive bacteria. Staph aureus is the
commonest bacteria found.
CONCLUSION:
Isolation and identification and understanding the bacteriology of diabetic foot infection help in
selecting the antibiotics and planning the proper management for diabetic foot infection.

BACKGROUND:
Schemic heart failure (IHF) is the most common cause of congestive heart failure. Several studies have
revealed that hyperglycemia is an independent risk factor for the progression of IHF in the general
population.
OBJECTIVE:
Is to evaluate the relationship between fasting blood glucose concentration and the development of IHF in
patients with CAD.
METHODS:
This study included 28 patients with IHF, 22 patients with coronary artery disease (CAD) without HF and
22 healthy controls. Fasting plasma glucose, total cholesterol, and low density lipoprotein-cholesterol( LDLC) were measured in these two groups of patients and controls.
RESULTS:
The present study revealed that the mean (± SEM) value of fasting plasma glucose in patients with IHF (127
± 7.64 mg/dl) was significantly higher than that obtained from CAD patients without HF (93.6 ± 3.96 mg/dl,
P<0.0001) as well as from healthy controls (80.8 ± 2.52 mg/dl, P<0.0001). The mean values (± SEM) of
serum total cholesterol and LDL-Cholesterol did not differ significantly among the three groups of the
present study.
CONCLUSION:
This study showed that serum glucose level may play an important role (partially) in the development and
progression of IHF in patients with CAD and normal cardiac contractile function.

BACKGROUND:
It is speculated that usual electrocardiographic manifestations of hyperkalemia are less pronounced in
patients with end stage renal disease ((ESRD)) than in those with normal renal function, those patients
usually have tolerance for hyperkalemia and the usual cardiac and neuromuscular sequalaes are less
evident possibly due in part to fluctuation in serum calicium concentraton .
METHODS:
We studied 70 consecutivly selected stable haemodialysis patients to determine the prevalence of ECG
changes of hyperkalemia, predialysis serum potassium concentration and pther electrolytes were
measured and smiltaneous 12- lead electrocardiogram obtained.
RESULTS:
The 70 study subjects ((35 males, 35 females )) age 45.5_+10.6((range 24-60)) mean duration of ESRD
was 22_+20 months((range4-60 )).
-Mean predialysis serum potassium concentration was 4.7 _+0,9mEq/L(range 3.5-7.1).
– Mean precordil leads T wave amplitude for entire group was 5.2_+4.4mm.
- Mean T wave to R wave ratio was 0.4 _+ 0.1 .
- Mean serum calcium concentration was 9.0_+0.61mq/dl(range 7.5-11.8).
-No study subject had evident arrhythmia.
-There was no significant difference in T wave amplitude (p=o.11)or T wave to R wave (p=0.12) between
quartiles of serum potassium concentration.
-Total serum calcium concentration had inverse relation with T wave amplitude ( p=0.007).
CONCLUSION:
Haemodialysis patients with hyperkalemia may not exhibit the electrocardiographic changes of
hyperkalemia, thus the absence of ECG changes in hyperkalemic haemodialysis patients should
interpreted with caution

BACKGROUND:
QT interval reflects depolarization and repolarization of the left ventricle, both QT interval and QT
dispersion in surface 12 leads ECG of diabetic patients increase with progression of cardiac autonomic
neuropathy(CAN) and this may lead to increase risk of dangerous dysrhythmias, it was found that there
was association of this phenomenon with other complications of diabetes as ischemic heart disease and
microalbuminuria.
OBJECTIVE:
To asses the relation of QTc and QTd to age ,duration of disease, gender, body mass index (BMI), and to
presence of peripheral distal symmetrical sensory neuropathy.
METHODS:
A longtudinal study of 38 diabetic patients type 2 complaining of distal sensory neuropathy , 12 leads ECG
done for all and QTc and QTd are measured with classical method, data collected from patients about age,
gender, duration of diabetes and their weight and high for body mass index (BMI).
RESULTS:
The result of this study declare that the sample mean age is 46.18 years, mean duration of diabetes is 8. 5
years, 57.9% are female , 42.1% male and 60% of them had BMI above 25 kg/m2. 31.6% of the patients
had prolong QTc and 42.1% had prolong QTd. 50% of those over 50 years had prolond QTc and 85% of
those over 40 years had prolong QTd inspite of that relation of prolongation to age is not significant
statistically(P more than 0.05), while the relation of QT intervals to duration of disease is significant
statistically, female gender show clear association to prolongation of both QTc and QTd which is
significant statistically (P less than 0.05) and inspite of the relation of prolongation of QT intervals to
increase in BMI but was not significant statistically.
CONCLUSION:
QTc and QTd prolongation is more common in diabetics who is complaining of symmetrical peripheral
sensory neuropathy specially if duration of diabetes is more than 5 years and more in females than males.

BACKGROUND:
Host immune response especially cell mediated immunity play an important role in the origin and
progression of head and neck cancer.
METHODS:
A total of 63 terminal untreatable stage IV head and neck cancer patients were investigated for cellular
immune response before and during S2- complex (synthetic -2) immunotherapy from 1992-1994 in Iraqi
Medical Collage – Al-Nahrain University. Cellular immunity were investigated including leukocytes,
lymphocytes, T and B lymphocytes and T lymphocytes subsets CD4+ , CD8+ and HLA-DR + cells using
monoclonal antibodies by indirect immunoflourescense test. Their results were compared with twenty
normal apparently healthy individuals.
RESULTS:
The mean total leukocytes and neutrophil numbers were significantly higher in head and neck cancer
(HNC) patients while lymphocytes numbers (T and B) were significantly low. Lymphocytes subsets
showed significantly decreased in CD4 % and CD8% not affected. CD4/CD8 ratio was lower than
normal. HLA-DR + cells were higher in HNC patients. S2-complex administration showed increased in T
and B cells on individual basis , increased CD4 , CD8, HLA-DR+ cells and CD4/CD8 ratio.
CONCLUSION:
Immunotherapy acts as an adjuvant to other modalities of treatment without affecting normal human cells.
S2-complex induced normalization of peripheral lymphocytes and cause immunorestoration of
immunologic function in vivo.

BACKGROUND:
Hodgkin disease is a lymphoid tumor that accounts for less than (1%) of all DeNovo neoplasms occurring
every year worldwide.
OBJECTIVE:
The aims of the study was to assess the expression of immunohistochemical markers namely (CD20,CD15)
in malignant cells of Hodgkin's disease.
METHODS:
Over the period extending from (January 2006-March 2008), specimens form 31 cases of lymphocyte
predominance Hodgkin lymphoma (Rye's classification) as formalin fixed, paraffin embedded tissue
blocks from excisional lymph node biopsies. For each case, five representative sections were prepared.
One stained with hematoxyline and eosine (HxE), and four other sections (on positively charged slides)
prepared for IHC procedures using CD15, and CD20. For the evaluation of markers expression, a
semiquantitative evaluation system was used to register the staining intensity and the numbers of positive
cells.
RESULTS:
The most common site of lymph node biopsy was the cervical lymph node in (61.2%) of cases.
Immunohistochemically, CD20 was expressed in (12.9%) of cases, while CD15 was expressed in (77.4%) of
cases.
CONCLUSION:
This study has shown that HD with a nodular growth pattern and a lymphocyte-rich background
encompasses 2 entities with distinct morphologic, phenotypical features. Therefore, the precise
classification of such case requires a combination of conventional histology and immunohistology with
distinct panel of antibodies.

BACKROUND:
The level of IgG increases during pregnancy reaching a maximal level at term and was clamed to
have a role in the immunological initiation of labor at term, some times the presence of infection
during pregnancy might increases the level of such antibody as part of the maternal humeral
immune response toward invading pathogens, among which U.T.I and chest infection.
OBJETIVE:
The evaluation of the role of placenta- bound IgG as a part of immune response against the
infectious agents causing UTI and or chest infection during the second half of pregnancy.
METHODS:
Fifty one women were included in this study delivered normally at Baghdad teaching hospital,17
women had UTI and 18 where complaining of chest infection at time of sample collection
compared with 17 women delivered normally and apparently healthy as a control group ,the level
of IgG was detected by direct immunoflorescent test (IF).
RESULTS:
The study showed a significant higher level of IgG in the placental biopsy of women with UTI, and
chest infection than those of the control group.
CONCLUSION:
The level of placenta –bound IgG is higher in women having infectious disease during pregnancy
than those with normal uncomplicated gestation, which could be considered as a reflection for the
level of passive immunity donated to the baby during his first six months of life.

BACKGROUND:
Angiolymphoid hyperplasia with eosinophilia (ALHE) (pseudopyogenic granuloma) is a benign locally
proliferating lesion composed of vascular channels with a surrounding infiltrate of lymphocytes and
eosinophils.
OBJECTIVE:
ALHE is a rare disease but in Iraq it apparently seems to be more common than expected, for this
reason the present work was arranged to evaluate the clinical and histopathological aspects of the
disease.
METHODS:
This case descriptive study was conducted in the Department of Dermatology & Venereology- Baghdad
Teaching Hospital during the period between June 1982- March 2005. Sixteen patients with this skin
problem were included in this study. All demographic points related to the disease were obtained from
each case through detailed history, close clinical and histopathological means.
RESULTS:
Sixteen patients with ALHE were evaluated. Their ages of patients ranged from 20-50 years with a
mean ± SD of 35.73 ± 8.72 years, they were 14 females and two males. The duration of the disease
ranged from 1 -15 (6.4 ± 4.42) years.
The clinical picture consisted of multiple dull to pinkish red angiomatous papules and nodules affecting
the head only mostly around the scalp and ears. The histopathological examination revealed a
proliferation & ectasia of blood vessels with eosinophilic infiltrate of the dermis.
CONCLUSION:
This study revealed that angiolymphoid hyperplasia with eosinophilia (ALHE) in Iraq, is a disease
predominantly of adult females only affecting the head, with no lymphadenopathy and typical
histopathology without lymphoid follicle formation. This is the first report describing this disease in
Iraq and seems to be more common than European countries.

Pectoralis major muscle or myocutaneous flap is
usually used for closure of big pharyngocutaneous
fistula. In case of partial or complete failure, the
plastic surgeon should be well prepared to use a
second option for closure weather using
myocutaneous or fasciocutaneous flaps, alone or
with combination. Deepithelialized Deltopectoral
flap found to be a reliable option.