Iraqi Postgraduate Medical Journal

BACKGROUND:
The aim of this study is to present our experience in the management of gastrointestinal tuberculosis in
Iraq.
PATIENTS&METHODS:
86 cases with intestinal tuberculosis were histologically proven by endoscopy or surgery, during the
period 1965-2004 at the Medical City Teaching Hospital, & two private hospitals (Alousi & Mustansiria),
Baghdad.
RESULTS:
54(62.8%) were female and 32(37.2%) were male. Age ranged from 6-82 years (mean 33yrs), peak 30-39
years. Clinical presentation were; intestinal obstruction 44(51.2%), abdominal mass 20(23.3%),
malabsorption 13(13%), massive gastrointestinal bleeding 3(3.5%), peritonitis 3(3.5%), pyloric
obstruction 2(2.3%) and dysphagia 1(1.2%) patients. Chest X-ray reported; normal in 62(72.1%), active
pulmonary tuberculosis in 3(3.5%), and healed lesion in 21(24.4%) patients. Barium study revealed
dilated bowel loops in 31(45.6%); other less frequent findings were strictures, filling defect, shortening
and bowel irregularity. OGD showed a significant pathology in 7 out of 11 patients examined. Ultrasound
showed helpful imaging modality in 15/21 patients; ascitis, masses, enlarged lymph nodes, and thick
bowel loops in some cases. Site of lesions were; ileocecal 42(48.8%), small bowel 33(38.4%), colorectal
8(9.3%) and stomach 3(3.5%) patients. Gross appearance were hyperplastic 33(38.4%), ulcerative
20(13.9%), strictures 21(24.4), and mixed 12 (13.9%) patients. Surgical procedures were; right
hemicolectomy 38(44.2%), resection of small bowel 23(26.7%), colectomy 4(4.7%), by-pass 4(4.7%),
stricturoplasty 2(2.3%), and subtotal gastrectomy 1(1.2%) and biopsy only 14(16.3%) patients. One
patient died post-operatively from pulmonary embolism, 6 lost to follow, 4 had relapse after stopped
treatment within 3-5 months (one of them died from intestinal obstruction) while the result in those
followed 74 (including 3 who relapsed and re-treated) patients whom received chemotherapy for over one
year were very satisfactory.
CONCLUSION:
Gastrointestinal tuberculosis affects females more than males. No age is immune, peak in 3rd decade.
Symptomatology is non-specific, it should be suspected in patients having abdominal pain, weight loss,
anorexia, fever, ascites and abdominal mass. Sub-acute or acute intestinal obstruction is the most common
presentation followed by abdominal mass or malabsorption in our study. Normal chest radiograph does
not exclude the presence of abdominal tuberculosis, but it should be suspected in high ESR patients.
Surgical interventions is not alternative to standard anti-tuberculous therapy

BACKGROUND:
The treatment of appendiceal mass is controversial. For patients initially treated conservatively with
antibiotics with or with out drainage, the role of interval appendectomy is an area of considerable debate.
AIM :
To evaluate the indications of interval appendectomy in patients presented with appendicular mass in
correlation with post operative histopathological results.
PATIENTS & METHODS:
This is a prospective study of 97 cases with the diagnosis of appendicular mass admitted and treated
conservatively in Baghdad Teaching Hospital during the period from December 2002 to December 2006
then scheduled for interval appendectomy. .Histopathology of the appendix examined and correlation of
the result with certain clinical characteristic of the patients .
RESULTS :
The prevalent age group was 30-39 years (39%) and male to female ratio was 2.8:1. Postoperative
histopathological features of the excised specimens showed that 85/97 (88%) of patients had chronically
fibrosed appendix with obliterated lumen. The remaining 12/97 ( 12%) of patients were having inflamed
appendices. There was a clear correlation the age of patient above 40 years (41%)and initial clinical
response (94%) with the histopathologic support for appendectomy .
CONCLUSION:
Interval appendectomy was mandatory in the following groups of patients:
Patients ≥ 40 years old.
Patients with poor initial response to conservative treatment.
Patients with recurrent symptoms.
Patients with WBC count ≥ 12000 cell/cc.

BACKGROUND:
Cervical lymphadenopathy is a common clinical problem that needs a prompt diagnosis to manage. FNAC
plays an increasing role in the differentiation of its pathology. The aim of this study was to show the value
of cytological examination in the assessment of cervical lymphadenopathy in relation to histopathological
examination.
METHODS :
A prospective study where 50 randomly selected patients with cervical lymphadenopathy underwent fine
needle aspiration cytology in the pathological department, college of medicine, Kufa university, for the
period from Feb.2004 to Feb.2005.
RESULTS :
Non specific lymphadenitis was the common pathology in 20 patients (40%), followed by tuberculous
lymphadenitis in 16 patients (32%), lymphoma in 22% and metastatic tumour in 12% of cases
respectively.In 44 patients out of 50 the the pathology was confirmed histopathologically.
CONCLUSION :
It is proved by this study that FNAC play an important role in the diagnosis of cervical lymphadenopathy
as accurate as histopathological examination.

BACK GROUND:
The cruciate ligaments consists of a pair of very strong ligaments, connecting tibia to femur crossing
like the limbs of letter X and that is why they are called crucial, mostly injured in noncontact sport
actions leading to knee instability.
AIM OF THE STUDY:
To determine the accuracy of the clinical approach in the diagnosis of ACL tear. We used diagnostic
arthroscopy as a reference standard for evaluating our results by applying it to all the patients.
METHODS:
During the period from Dec-2000 to Oct-2002, we led a prospective study of 72 patients with
suspected ACL tear, depending on careful history & physical examination, then confirmed by direct
arthroscopy.
RESULTS:
We found that only 52 patients have got ACL tear, 49 of them (94%) were males & 3 (6%) were
females. The age range was from 17-49 years, with a mean of 27.5 years, 42% of the patients had
associated meniscal injuries. The commonest symptom was a heard pop, & the main sign detected
was knee joint effusion due to haemarthrosis.
The accuracies of Lachman test, Anterior Drawer Test & Pivot Shift T. were 94%, 82% & 58%
respectively, all were improved under G.A., particularly the PST.
CONCLUSION:
Most of ACL tears can be diagnosed by thorough history& repeated clinical examination only,
considering arthroscopy as a last but a definite choice.

BACKGROUND:
Abdominal incisional hernias are a common condition in practice. Numerous surgical procedures
have been used to repair them with different results.
OBJECTIVE:
This study aims to find the place of shoelace darn in the repair of incisional hernias.
METHOD:
One hundred patients with abdominal incisional hernias have been managed by a shoelace darn
repair., The details of the operative technique have been described.
RESULTS:
shoelace darn repair was an easy procedure associated with some complications, and followed by
recurrence in 4 patients. The age, sex, clinical presentation, the type of previous surgery, the type of
incisional hernia, the body built of the patients were discussed .
CONCLUSION:
Shoelace darn repair have got a good place in managing abdominal incisional hernias.

BACKGROUND:
Acute pancreatitis has traditionally been defined as an acute inflammatory process of the pancreas
that (1) is associated with abdominal pain and elevations in serum levels of pancreatic enzymes
and, (2) disrupts normal pancreatic architecture and function.
AIM OF THE STUDY:
To assess the serum level of zinc and copper in patients with acute pancreatitis.
METHOD:
A study conducted in Gastrointestinal Teaching Hospital in Baghdad, from first May 2005 to first
March 2006, twelve patients were eligible in this study, and they were 4 females & 8 males. Zinc
& Copper were measured for every patient by Perkin-Elmer (USA) atomic absorption
spectrophotometer model 305B fitted with nitrous oxide acetylene burner head.
RESULTS:
Zinc & Copper concentrations were significantly decreased (p <0.001 and p<0.0001 respectively)
in the serum of acute pancreatitc patients.
CONCLUSION:
These findings of Zinc & Copper levels suggest that altered minerals metabolism in serum may
have contributed to the pathophysiology of acute pancreaitits.

BACKGROUND:
Antiandrogens have been developed to treat acne; spironolactone, an androgen receptor blocker, and
finasteride, 5 alpha reductase inhibitor, are two antiandrogens that can be used to treat acne vulgaris.
OBJECTIVES:
To evaluate the effectiveness and safety of spironolactone , finasteride, and combination of both drugs
in the treatment of acne vulgaris.
PATIENTS&METHODS:
This single blinded uncontrolled clinical therapeutic trial was done in the Department of Dermatology
and Venereology – Baghdad Teaching Hospital- in a period from December 2004 to October 2006.
The patients were classified according to the number of inflammatory lesions as having mild,
moderate and severe acne. Severe acne was excluded from the study. History & close examination
were performed to all patients regarding all points related to the disease. Sixty-nine patients with acne
were divided into three groups and were instructed to take the following drugs for two months; group
A: spironolactone 100 mg/day, group B: finasteride 5 mg/day, and group C: combination of both
drugs.
The clinical assessment was done by counting the number of inflammatory lesions every two weeks
for two months, recording any local or systemic side effects, & comparison between the number of
inflammatory lesions before and after treatment was done.
RESULTS:
Sixty patients had completed this work, whose mean± SD of their ages of the three groups totally was
18.8 ± 2.3 years and for group A, group B, and group C as follow : 19 ± 2.6, 19.3 ± 1.9, and 18.1 ± 2.4
respectively, with 20 patients in each group.
Spironolactone was statistically significant in reducing the number of inflammatory lesions,
finasteride was beneficial but did not reach a statistically significant level as spironolactone, and
combination of both drugs was more effective in the treatment of acne vulgaris than spironolactone
alone but did not reach a statistically significant level.
CONCLUSION:
Spironolactone is a good alternative drug to be used in patients with acne singly or in combination
therapy with finasteride.

OBJECTIVE:
To compare the contribution of squamous cell and transitional cell types to the schistosoma – related
and schistosoma – unrelated bladder cancer among Egyptian patients and to evaluate any significant
association of carcinoma in situ (CIS) and stage T1 – TCC in schistosomiasis.
MATERIALS AND METHODS:
A retrospective study in which the histopathologic records of 196 patients who underwent radical or
salvage cystectomy for bladder cancer from August 1994 to December 2000 in Urology and
Nephrology Center/ Mansoura University – Egypt, had been carried out.
RESULTS:
The age range of patients was (29 – 75) with a mean of (55.82 ± 8.81) years. Histopathologic
examinations of cystectomy specimens showed schistosomiasis in 81(41.32%) patients while in 115
(58.67%) patients; bladder cancer was schistosoma – unrelated. The cell type of cancer in (80)
patients with schistosomiasis, was transitional cell carcinoma (TCC) in 40 (50%), squamous cell
carcinoma (SCC) in 37 (46.25%), and adenocarcinoma in 3 (3.75%) patients. In schistosoma –
unrelated bladder cancer, TCC was reported in 76 (66.08%), SCC in 34 (29.56%), undifferentiated
carcinoma in 4 (3.47%) and adenocarcinoma in 1 (0.86%) patients. CIS associated with (stage T1 –
TCC) was reported in 2 (15.38 %) out of 13 patients with schitosoma – related bladder cancer, while
it was reported in 3 (14.28%) out of 21 patients with schistosoma – unrelated bladder cancer. There
was no significant statistical difference between the two groups.
CONCLUSION:
Schistosoma – related bladder cancer is still a problem in countries endemic with schistsomiasis.
Although the major histological cell type in such cancer is SCC, there is a trend of increasing
frequency of schistosoma – related TCC.

OBJECTIVES:
To ascertain the relationship between diabetic voiding dysfunction and vesico-sphincteric behavior,
and try to point out any clinical prediction to bladder cystopathy in diabetic patients.
METHODS:
Fifty-one diabetic patients complaining of voiding disorders were studied over two years (Oct/2000-
Oct/2002), according to history, clinical examination and investigations especially full urodynamic
assessment, patients were classified urodynamiclly as either impaired detrusor contractility, detrusor
hyperreflexia , detrusor areflexia , and normal.
RESULTS:
Mean bladder capacity was 479±123.9ml. with a mean first sensation of filling of 241.1±61.2ml. of
the 55 patients 23(45.3%) impaired detrusor contractility), 18 (35.2%) had detrusor hyperreflexia, 4
(7.8%) had detrusor areflexia, and 6 (11.7%) were normal. The presence of sacral neurological signs
and infection were found statistically significant in predicting an abnormal urodynamic pattern, while
neither age, sex, nor the type and severity of diabetes were found related.
CONCLUSION:
These data suggest that classical diabetic cystopathy is not the most common urodynamic findings in
patients with diabetes mellitus and voiding dysfunction, and in fact these patients present with
variable pathophysiological findings. These findings demonstrate the importance of urodynamic
studies in diagnosing voiding dysfunction in diabetics before initiation of therapy.

OBJECTIVE:
To assess the incidence, and pattern of autonomic dysfunction in Iraqi systemic lupus erythematosus
(SLE) patients and its possible association to patient’s age, duration of disease, SLE activity, drugs
used &autonomic nervous system symptoms.
PATIENTS AND METHODS:
Fifty Iraqi SLE patients and 50 healthy controls were included in this study. Full history was taken and
complete clinical examination was done for all individuals in both groups. Disease characteristics [age,
sex, duration, SLE disease activity index (SLEDAI), drugs used, and autonomic nervous system
symptoms] were also documented. Laboratory analysis included complete blood count, general urine
examination, and anti-double stranded deoxyribonucleic acid. Individuals in both groups were assessed
for autonomic dysfunction using 5 non-invasive tests: heart rate response to Valsalva maneuver, heart
rate response to deep breathing, and heart rate response to immediate standing (30:15 ratios), systolic
blood pressure response to standing and diastolic blood pressure response to sustained handgrip.
Autonomic dysfunction was categorized as normal, parasympathetic, sympathetic, and mixed pattern
according to criteria proposed by Ewing.
RESULTS:
Forty three (86%) Iraqi SLE patients have autonomic dysfunction compared with 0 % of controls
(p=0.00000000001) and the most common autonomic function pattern was the mixed pattern 28(56%)
patients. There was no statistical significant association between autonomic function pattern and age
group of patients (p=0.536). Also no statistical significant association were observed between
autonomic dysfunction; and age, sex, disease duration, disease activity (SLEDAI),autonomic nervous
system symptoms or drugs used (chloroquine, prednisolon, azathioprine) (p=0.434, p=0.213, p=0.405,
p=0.450, p=0.069, p=0.935, p=0.204, p=0.443 respectively).
CONCLUSION:
The incidence of autonomic dysfunction in Iraqi SLE patients using non-invasive tests is high (86%)
and the most common pattern was the mixed pattern (56%). Also there was no statistical significant
association observed between autonomic dysfunction and age, sex, duration, SLE disease activity index
(SLEDAI), drugs used, and autonomic nervous system symptoms.

BACKGROUND:
Respiratory distress (RD) is among the most common symptom complexes seen in the newborn infant. It
may result from both non-cardiopulmonary and cardiopulmonary causes.
OBJECTIVES:
This study Aimed to assess some possible risk factors, types, and short term out come of RD in full term
newborns.
PATIENTS AND METHODS:
A case control study extending along a 6 months period from 1 st of October 2006 to 31 st of march 2007,
during which a 50 full term newborns with RD, who were admitted to the NICU of Baghdad Teaching
Hospital in Medical City-Baghdad, and enrolled with another 50 full term newborns without RD delivered
in the same period, in the same place.
For studied groups (cases and controls), a full prenatal and natal history, and complete physical examination
were done, including Down's score evaluation of RD. For each patient in the studied group, CXR, CBP,
CRP, Bl.C/S were under taken, close observation and out come were recorded.
RESULTS:
The risk factors that emerged as being significant includes: history of maternal smoking, caesarian section
delivery and male sex .The elective caesarian delivery was highly significant risk factor for RD in full term
newborns. The percentage of RD in full term newborns to the total live births at that period was (2.16%),
TTN was the commonest cause (1.68%), followed by HMD (0.25%), MAS (0.086%), CHD (0.086%) and
then C. P (0.001%).
CONCLUSION:
That RD in full term newborns is still an important problem in this NICU, especially due to TTN and
following elective CS. These prompt us to recommend the reduction of these risk factors especially elective
CS to decrease the percentage of RD in full term newborn babies.

BACKGROUND:
Diarrhea is best defined as excessive loss of fluid and electrolyte in the stool,Diarrhea is a major cause of childhood morbidly and mortality worldwide. Lactose intolerance is a clinical syndrome of one or more of the following ,abdominal pain , diarrhea, nausea,flatulence,and/or bloating after the ingestion of lactose or lactose_containing food substances.
THE AIM OF THE STUDY:
was to estimate pH and reducing substance in stool of children .
METHODS:
A prospective study done at pediatrics teaching hospital in Erbil from first March 2006- 31-August 2006 to review the stool PH and reducing substances in diarrhea.
RESULTS:
The majority of positive cases (CHO intolerance) were below 1 year in both types of diarrhea. Those patients with chronic diarrhea more susceptible to develop CHO intolerance. Both sexes approximately affected but in chronic diarrhea appear more in male. Vomiting was one of the common associated symptoms and the stool usually was watery in character. The disease more common in those children on bottle feeding. The excoriation of buttock nearly always present due to acidification of the stool.
CONCLUSION:
CHO intolerance (particularly lactose) occurs in acute and chronic diarrhea, but more in chronic one.Excoriation of buttock nearly always present.The disease was more common in those on bottle and mixed feeding

BACKGROUND:
Chronic renal insufficiency (CRI) causes substantial morbidity in virtually every major organ system
of the body. Moreover; CRI is inevitably progresses to end stage renal disease.
OBJECTIVE:
To find out the frequency of chronic renal failure in pediatric age group and their risk factors.
METHODS:
One hundred ten infants, children and adolescents with chronic renal failure age between 1 mo.-17 yr.
visiting Al-Karama Teaching Hospital in nephrology, urology, dialysis and transplant units for the
period from1st May 2004 until 30th April 2006 were included in this study. Patient's notes were
reviewed for: Age, sex, age at first presentation, age at referral to pediatric nephrologists , medical
and social history including mode of their RRT, then the cause of their renal failure. Every patient
was clinically examined and blood pressure. Measurement was taken, followed by taking
anthropometric measurements which includes body weight (Kg) and height (cm) in addition to
assessment of sexual maturity rate stages lastly we record laboratory investigation which include
blood urea, S. creatinine, Hb. level , S. Ca+2, S.Ph., and GFR in addition to any investigations
regarding original renal disease.
RESULTS:
In this study we found that males are more affected than females in a ratio of 3.2/1. The mean age at
their 1 st presentation were 3.5  3.7 yrs. while their mean age when they referred to pediatric
nephrologists were 5.2  4.4 yrs. Below 5 yrs. constituting 44.5% and age group between 6-10 yrs
constituting 29.1% while in age group above 10 yrs were 26.4%. Mean value of GFR in this study
was 14.2  7.5 ml/min/ 1.73m2, 36.4% patients were in ESRD. Obstructive uropathy as a cause of
CRF were in 34.5% of total patients, followed by glomerular diseases that involves 21.8% and
congenital anomalies of urinary system in 20.9% of our patients in this study. About 80% of our
patients were found to be anemic with Hb concentration  10 g/dl and 48.1% of patient having
hypocalcemia with S. Ca+2 level <9.5 mg/dl and hyperphosphatemia with S.Ph. >5.5 mg/dl found in
32.7% of patients.This study shows a significant relationship between hypocalemia and
hyperphosphatemia and anemia with progression of renal insufficiency to ESRD. About 45.5% and
53.6% were below 3 rd centile for Wt. and Ht. respectively and more than 50% had delayed puberty on
SMR staging of Tanner and those patient's with growth retardation are significantly increased in
number as the disease progressed to ESRD.Hypertension considered in patient with BP > 95 th
percentile according to task force table for age and sex and wt. and Ht. percentile and accordingly our
study show that about 45.5% of patients were HTN. Mode of RRT is mainly conservative and
intermittent peritoneal dialysis in 41.8% and 40% of our patients respectively. While only one patient
was on APD and 11 patients were on HD and 8 patients received lived related & unrelated renal
transplant.
CONCLUSION:
The obstructive uropathy is the commonest cause for CRF especially in children <5 yrs. Most of our
patients were of delayed referral to pediatric nephrology and they are poorly managed, severely
affected and growth retarded. We have limited diagnostic resources & options regarding pediatric
dialysis programs & renal transplant.

BACKGROUND:
Limited data are available with regard to the relation between maternal and fetal serum lipid and
lipoprotein levels and the mode of delivery.The aim of this study is to evaluate the effect of mode of
delivery on the levels of serum lipid and lipoprotein of mothers and their umbilical cords.
METHOD:
This study is consisted of fourty-nine pregnant women delivered by elective caesarean(CS)and seventyfive age-and gestational age-matched pregnant women who delivered by normal vaginal
delivery(NVD).Serum lipid profile parameters including; total cholesterol(Tch),triglyceride(TG),high
density lipoprotein-cholesterol(HDL-C) and low density lipoprotein-cholesterol(LDL-C)were measured in
the serum of these two groups of pregnant women as well as in the serum of their umbilical cords.
RESULTS:
The mean(±SEM) values of serum Tch,TG,and LDL-C were significantly higher in pregnant women who
delivered by NVD when compared with those of pregnant women delivered by CS(all P< 0.001).With
regard to serum HDL-C mean value there was no significant difference between these two
groups.Similarily,the mean (±SEM) values of serum Tch,TG,LDL-C were significantly increased in
umbilical cord of NVD mothers in comparison with values obtained in umbilical cord of CS mothers( all
P< 0.001).
There was also a significant positive relationship between mothers and umbilical cord serum Tch levels in
NVD group(r=0.339, P< 0.001).
CONCLUSION:
This study revealed that the mode of delivery ,in particular, NVD changes significantly the concentrations
of lipid parameters mainly Tch,TG,and LDL-C.Such changes require an important attention postpartumly
for such mothers with respect to biochemical investigation,particularly lipid parameters.

BACKGROUND:
The reticuloendothelial system (RES) play an important role in immunity against bacterial infection
and Klebsiella pneumoniae one of the most common causes of hospital-acquired infections.
Dextran70 (D70), a polysaccharide, may alter functions of this system through changing many
biological activities in the tissues.
OBJECTIVE:
This study focuses on the prophylactic effects of D70 on RES in systemically challenged mice with
K. pneumoniae which has been isolated from urine sample of patient with urinary tract infection.
METHODS:
Four groups of adult white mice were intravenously injected with K.pneumoniae. Three groups of
them was preinjected intraperitonealy for three successive days with 0.5 , 1, and 2 mg D70/100 g
body weight, and the fourth group was challenged only as a control group. The ratio of liver and
spleen weights to body weight was calculated and histological sections for heart, lung, and kidney
were examined after 24 and 48 hours from challenge in all groups.
RESULT:
The results revealed that an increasing in the ratio of liver weights to body weight in control group,
while there is slight increase in the three groups treated with D70. The ratio of spleen weights to body
weight was more increasing after 24 hours in both 0.5 and 2 mg D70/100 g body weight of treated
groups. The histological study demonstrated suppurative lesions and abscesses in the heart, lung, and
kidney due to K. pneumoniae infection in the control group, while pretreated mice with D70 have
clearly demonstrated less pathological changes and more integrity of the tissues comparative to
control group.
CONCLUSION:
This study confirmed that D70 has a protective role and may be prophylactic effects against systemic
bacterial infections.

Glomus jugulare tumors (Paraganglioma) are very
slowly growing tumors; arise from non-chromaffin
paraganglionic tissue situated in close relationship
to the middle ear. It may originate from Glomus
bodies in the adventitia of the dome of the jugular
bulb (Glomus Jugulare). The ganglionic tissue of
glomus bodies is derived from the neural crest and
is widely distributed in the autonomic nervous
system. Guild (1953) discovered the presence of
glomus ganglionic tissue within the temporal
bone, in close relation to the jugular bulb in 50%,
and on the mucosa of the promontory of the
middle ear 25%. (1) Rosenwasser (1945) was the
first surgeon to recognize the relationship between
these tumors and the normal glomus jugulare. (2)
These tumors have well defined thin fibrous
capsule. Histological examination shows similar
appearance to the normal glomus jugulare. The
cells of the tumor usually have no endocrine
function. They are not very active with only rare
mitotic figures & usually of low malignancy, very
rarely have nodal or distant metastasis. However,
clinically they are invasive and destructive to the
temporal bone and the facial nerve. They readily
infiltrate the cellular system of the mastoid.
Glomus jugulare shows predominance in females
of 6: 1 and tends to be more common in the
middle age group with familial and hereditary
patterns (3). Jugular bulb tumors may present a
syndrome of paralysis of 7th, 9th, 10th and/or
perhaps 12th cranial nerves, deafness, tinnitus and
vertigo.