Iraqi Postgraduate Medical Journal

BACKGROUND:
Pulmonary metastases are common showing high prevalence in patients with extrathoracic
malignancies and a figure of 20-54% is mentioned according to an autopsy study . As many as
90% of patients with lung metastases have a known extrathoracic primary tumor or symptoms of a
synchronous primary tumor and chest symptoms are usually absent in patients with multiple
metastases (80-95%).
AIM OF STUDY:
To elucidate the most common findings detected by chest CT in patients with pulmonary
metastases, to be familiar with in the management & follow-up of these patients.
METHODS:
The study was conducted on forty-two patients with definite primary extrathoracic malignancies
by chest spiral CT(SOMATOM PLUS 4 by Siemens medical systems), those with multiple
pulmonary metastatic nodules were selected. Data were collected regarding CT characteristics of
the pulmonary nodules and the extraparenchymal chest lesions involving the pleura, lymph nodes
and of chest wall bones.
RESULTS:
The forty-two patients (twenty-seven females and fifteen males), 81% of them were above forty
years. The most common (59.5%) primary tumor was breast carcinoma .All patients had
pulmonary nodules enhancing more than 20 Hounsfield units (HU) and (59.5%) of them showed
nodule enhancements ranging from 30HU to 50HU.Cavitatng and calcified pulmonary nodules
were seen in 9.5% and 2.4% of all patients respectively. Extraparenchymal chest lesions were
found collectively in 33.3% of all patients, the most common finding of which were pleural
effusion and intrathoracic lymphadenopathy (14.2% and 9.5% respectively), while bone metastases
was shown in 7.1% of patients.
CONCLUSION:
We concluded that the most common findings detected by chest CT in patients with pulmonary
metastases are the enhancing nodules with enhancements of more than 20 Hounsfield units & the
extra-parenchymal chest lesions, while other findings like cavitation and calcification are unusual
and occur with certain primary tumors.

BACKGROUND:
Evaluation of jaundiced patients should include proper history and examination, laboratory investigation
and imaging investigations (non invasive like U\S, CT and MRI or invasive like ERCP and PTC).
AIM OF STUDY:
The aim of this prospective study is to evaluate the role of U\S and MRI-MRCP in patients with
obstructive jaundice in clinical practice.
METHODS:
This is a prospective study performed on 80 patients (42 female and 38 male) with an average age of 53
years presented with obstructive jaundice for whom abdominal ultrasound (U\S) and magnetic resonance
imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) performed in the departments
of radiology in Al-Kadhemiyyah teaching hospital and Specialized surgical hospital and Baghdad
teaching hospital from October 2003 to October 2005. The final diagnosis was found by endoscopic
retrograde cholangiopancreatography (ERCP) and \or surgery and confirmed by histopathology.
RESULTS:
The most common cause of obstructive jaundice in our study was tumors (41.25%) followed by common
bile duct stones (36.25%) then benign strictures (13.75%), hydatid cyst (6.25%) & finally choledochal
cyst (2.5%). In this study, MRI-MRCP could differentiate surgical from medical jaundice in all cases,
while U\S could differentiate surgical from medical jaundice in 91.25% of cases. MRI-MRCP correctly
defines the level of obstruction in all cases (100%).While U\S correctly define the level of obstruction in
only 86.2 % of the total cases. MRI-MRCP correctly suggests the most possible cause of obstruction in
96.25% of cases. While U\S correctly suggests the most possible cause in only 36.2 %.
CONCLUSION:
So that U\S, as a screening modality is useful to confirm or exclude biliary dilatation & to choose
patients for MRCP examination. MRI-MRCP is a useful non-invasive and essential method in the
preoperative evaluation of patients with obstructive jaundice. In addition MRI-MRCP was superior to
U\S or ERCP in studying the extent & staging of malignant lesions.

BACKGROUND:
There are many technique of foreskin transposition, which may be employed in conjunction
with any of the technique for reconstruction of neourethra.
OBJECTIVE:
The aim is to evaluate the result of the whole penile foreskin transfer to resurface the shaft
after reconstruction of neourethra by a modified Mustarde technique.
METHODS:
Sixty hypospadias patients, thirty one with distal penile type and the other twenty-nine were
midshaft penile type, treated by Glenn Shepard modification of Mustarde technique to
reconstruct neourethra, the whole foreskin transport and wrapped around the shaft.
RESULTS:
The minimal fallow up was 8 months. The functional and the cosmetic result were
satisfactory for most of the patients with three exceptions which represent 5% of the cases
who ended in complete failure and other complications were minor.
CONCLUSION:
The whole foreskin flap wrapped around the shaft to resurface the whole shaft including the
neourethra may minimize the risk of fistula formation. Securing the neourethra to the
corpora by several interrupted absorbable suture provide adhesion of the tube to bed and
may give better chance of healing and prevent twisting of the tube, firm and uniform
dressing is essential.

BACKGROUND:
Benign prostatic hyperplasia (BPH) is one of the most common diseases of the aging male.
Minimally invasive therapies for treatment of BPH compete with the gold standard transurethral
resection of the prostate (TURP). The aim of this study is to assess the efficacy of transurethral
microwave therapy (TUMT) in patients with otherwise poor general health.
METHODS:
Thirty (30) patients with associated chronic medical diseases and lower urinary tract symptoms due
to BPH were subjected for TUMT as an outpatient single session procedure, from June 2001 to
August 2005. Follow up was performed 2 weeks, and then one month following treatment clinically
and by assessing residual urine volume, maximal flow rate and prostate size.
RESULTS:
Out of (28) treated patients, (21) were labeled as non – responders as they were unable to pass urine
freely 2-weeks after a trial of decatheterisation. In contrast (7) patients passed urine freely after
decatheterisation. In the latter group, it was found that there was no statistical significance of the
values of maximum flow rate, residual urine volume or prostate size between pre- and one month
post TUMT.
CONCLUSION:
TUMT is a possible option for the treatment of BPH in poor general health patients or those refusing
other surgical modalities. However, it did not prove to be effective for those patients with chronic
urinary retention and BPH.

OBJECTIVES:
To show the correlation of postoperative wound infection with intraoperative culture results and
duration of operation.
METHODS:
Prospective studies of 168 randomized patients in which a wound swab was taken at wound closure
and send for culture results, another swab taken if the wound become infected 5-7 days postoperative
and send for culture to show the correlation of postoperative wound infection with intraoperative
culture results in al-NAJAF teaching hospital from Jan.2003 to Jan.2004. Wounds are classified in to
clean, contaminated and dirty surgery.
RESULTS:
In clean surgery the contamination rate was 7.4% and infection rate was 3.7 %, while in contaminated
surgery the contamination rate was 27.7% and infection rate was 11%, while in dirty surgery the
contamination rate was 35.9% and the infection rate was 25.6%. The results were compared with
other studies of the world. Pseudomonas aeruginosa and S. aureus are the most common
microorganisms to produce wound infection which are a serious microbe and are mostly hospital
acquired and resistant to most of the commonly available antibiotics. As regards to relation of
postoperative wound infection and duration of operation our results shows that long operations has a
higher infection rate (more than 1 hour was 65.4% from the total cases) while the infection rate in
surgical operations less than 1 hour was 34.6%,so infection rate is doubled by operations lasting more
than one hour.
CONCLUSION:
The study showed a higher infection rate in clean surgery due to weak sterilization and poor
preoperative preparation of the patients and the role of postoperative antibiotics in reduction of wound
infection by about 38%.

BACKGROUND:
Thyrotoxicosis is a common disease which might require surgery. Thyroidectomy without preoperative
preparation exposes the patient to the fatal risk of thyrotoxic crisis. Neomercazole is the standard
preoperative regimen. Propranolol might be an ideal alternative.
OBJECTIVE:
This study aims to demonstrate the safety and the convenience of the Beta-blocker propranolol in the
preoperative preparation of the thyrotoxic patients.
METHODS:
Over a period from. 1998 to 2006 fifty patients undergoing thyroidectomy for thyrotoxicosis in private
and governmental hospitals were preoperatively prepared using propranolol alone.
RESULT:
Propranolol was very rapid in controlling thyrotoxicosis in a dose of 160-480 mg/day. The operative and
postoperative periods went on smoothly without any complications.
CONCLUSION:
Propranolol is a cheap, safe and effective in the preoperative preparation of the thyrotoxic patients and
might be used as a routine.

BACK GROUND:
To determine the prevalence of H.Pylori infection in adults undergoing oesphagogastrodudenoscopy
by two methods serology (ELISA technique) comparing it with histopathology.
METHODS:
Forty patients referred to the GIT clinic of AL-Yarmok teaching hospital for GI endoscopy were
involved in this study; their biopsies and sera send to histopathology and immunology department
respectively for detection of H.Pylori.
RESULTS:
H.Pylori Abs(IgG) were detected in the sera of 25(63%) patients by ELISA,15 (37.50%) of them
H.Pylori was also seen in their biopsies by Giemsa s stain. Most patients with detectable antibodies
are those with chronic gastritis ;however patients complaining from reflux oesophagitis showed a
significant absentees of these Abs.
CONCLUSION:
Most patients with gastritis had detectable H,Pylori Abs in their sera; However the study reveled a
significant decrease in H.Pylori Ab detection in patients sera with reflex esophagitis (R.O).

BACKGROUND:
Serum thyroid hormone level can provide a quantitative index for evaluating the severity of chronic
heart failure.
OBJECTIVES:
To assess the contributions of thyroid hormones [tri-iodothyronine] (T3) and thyroxine (T4)] to the
left ventricular (LV) dilatation and myocardial dysfunction in patients with idiopathic dilated
cardiomyopathy (IDC).
METHODS:
Forty patients with idiopathic dilated cardiomyopathy (IDC) aged 46.20 + 1.90 years, as (mean ±
SEM) (11 females and 29 males) were studied. Serum total T3, total T4 and thyroid-stimulating
hormone (TSH) were measured in these patients. Echocardiographic parameters including LV
systolic diameter, septal thickness systolic diameter, LV diastolic diameter, septal thickness diastolic
diameter and LV ejection fraction (LVEF) were also be assessed in all patients.
RESULTS:
This study showed that the serum T4 values were significantly directly correlated with the values of
EF % (r = 0.34; p < 0.035) along with significant inverse relationship between serum levels of T 3 and
the diameter of LV systole (r = - 0.34; p< 0.032).
CONCLUSION:
This study revealed an important significant correlation between serum thyroid hormones levels and
echocardiographic parameter values that may point to the role of these biochemical factors in the
contribution to the LV dilatation and cardiac dysfunction (heart failure) .

BACKGROUND:
It has been speculated that trace elements may play a role in the pathogenesis of dilated
cardiomyopathy (DCM) .In the present study, we aimed to assess serum concentrations of selenium
(Se) in Iraqi patients with idiopathic dilated cardiomyopathy (IDC) and to evaluate the correlation
between serum Se concentrations and echocardiographic parameters.
METHODS:
This study included 28 patients with IDC and 22 healthy controls .Serum level of selenium was
measured by atomic absorption spectrophotometry method .Echocardiographic parameters including
left ventricular end diastolic diameter (LVEDD), LV end- systolic diameter (LVESD) ,and LV ejection
fraction (LVEF) were measured in all patients with IDC in order to evaluate its correlation with serum
Se concentrations.
RESULTS:
Serum concentration of Se in IDC patients was significantly lower than in healthy controls
(p<0.001).Relationships of the serum Se levels with echocardiographic and clinical parameters were not
statistically significant.
CONCLUSION:
The present study confirmed that IDC is associated with decreased serum Se concentrations. This
change in Se may play an important role in the pathogenesis of myocardial damage in IDC.

BACKGROUND:
There is a suggestion that abnormal coronary physiology may be exist early in the course of
idiopathic dilated cardiomyopathy (IDC), and is likely to play an important role in the pathogenesis
and progression of the myopathic state in such patients. With regard to lipid profile, high-density
lipoprotein cholesterol (HDL-C) particle enhances NO production and improves endothelium
relaxation.
METHODS:
This study included 50 patients aged 19-72 years (13 females and 37 males) with IDC and 23 healthy
controls aged 29 to 60 years (9 females and 14 males). Lipid profile, should be at least 12 hours
fasting, including serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density
lipoprotein cholesterol (LDL-C) and triglyceride (TG) were evaluated in these two groups.
Measurements of some of echocardiographic parameters including left ventricular (LV) systolic and
diastolic diameters, and LV ejection fraction (LVEF) in IDC patients, and correlate its values with each
one of the above lipid parameters in order to define the more predictor lipid parameter in evaluating
the structure and function of the heart.
RESULTS:
The mean values of serum total cholesterol and LDL-C were insignificantly higher in patients with
IDC patients than in controls. The mean of serum HDL-C was significantly low in IDC group against
controls (P< 0.001). The mean (± SEM) serum triglyceride TG levels in patients with IDC was
significantly increased when they were compared to that of normal controls (P< 0.05). An important
inverse relation was observed between serum levels of HDL-cholesterol and LV diastolic diameter
values (r= - 0.29, P< 0.039) as well as between HDL-cholesterol levels and LV systolic diameter values
(r= - 0.33, P< 0.02). A borderline significant positive correlation between serum concentrations of HDLcholesterol and the values of EF % was also shown in the IDC patients
(r= 0.28, P< 0.05).
CONCLUSION:
The result of this study may point to the role of HDL-C in contribution to the LVdilatation and
myocardial dysfunction (heart failure) in IDC.

BACKGROUND:
lupus nephritis is a fatal complication of systemic lupus erythematosus (SLE), the serological
hallmark of SLE is the presence of circulating autoantibodies directed against a wide variety of
nuclear, cytoplasmic and plasma membrane antigens among which are anticardiolipin (ACL),antiB2glycoprotein and anti-C1q antibodies, together with the consumption of complement component
(C3 &C4) by immune complex mediated reaction.
AIM OF STUDY:
To shed light on the relations among these autoantibodies and with complement component in lupus
nephritis patients.
METHODS:
Tthe study was conducted on 25 patients with lupus nephritis, attended the renal clinic in specialized
surgical hospital/ medical city /Baghdad, 25 lupus patients without nephritia and 25 healthy controls.
Enzyme linked immunsorbant assay was used for detection for ACL, anti-B2GP, anti-C1q, while
single radial immundiffusion plates used for the estimation of C3& C4.
RESULTS AND CONCLUSION:
Anticardiolipin antibodies correlated significantly with anti-B2GP IgG & IgM (P<0.05), anti-C1q
antibodies (P