Medical Journal of Babylon

Aim of the study: To assess the morbidity and efficacy of bipolar radiofrequency thermal ablation tonsillectomy and compare it with traditional cold dissection tonsillectomy in children. Materials and Methods: 100 patients between the age of 3-10 years admitted for elective tonsillectomy with recurrent or chronic tonsillitis or obstructive tonsillar hypertrophy. Half of them had traditional cold dissection tonsillectomy and the other half had tonsillectomy by bipolar radiofrequency thermal ablation, there is no intergroup difference in age,sex and weight. Results: The mean operative time is longer in the coblation group, and the estimated blood loss is little more in the coblation group than the traditional. The post operative pharyngeal or ear pain score is much less in the coblation group and there was no higher risk of bleeding in the coblation tonsillectomy than the traditional tonsillectomy. Conclusions: Coblation tonsillectomy has the advantage of less post operative pain and there is no higher risk of post operative bleeding between the two groups.

Objective: To compare diagnostic accuracy of saline-sonography ,hystro-salpingography and
laparoscopy in assessment of tubal pathology in infertility in women.
Study Design: Prospective study on one hundred infertile women in Babylon Maternity and Pediatrics
Teaching Hospital had undergone tubal patency assessment with saline-sonography ,hystrosalpingography
and laparoscopy from June2008 till June 2009,their ages between 18-43 years.
Results: Hystrosalpingography has sensitivity of 83.6 percent and specificity of 66 percent in
predicting tubal pathology and saline-sonography has sensitivity of 89.4 percent and specificity of 90.6
percent for detecting tubal patency. Laparoscopy been of choice for tubal pathology as detection and
treatment, but initial assessment of tubal patency for infertile women using saline-sonography as safe ,
noncosty,with-outradiationhazards.

Aim of study: evaluate the level Anti-tissue transglutinmase Anti body titer with the histopathological
marsh classification in celiac disease patients
Patients and materials: Fifty patients included in this study through the period between 2009-2010
All patients on gluen diet at the time of serum collection and histiopathological biopsy. all the patients
included in this study above the age of 18 years . 44 patients present with G.I.T. symptoms 6 patients
presented with non gastrointestinal symptoms oral endoscopic biopsy was taken from duodenum, The
biopsy put in formalin fixation(10%), paraffin block and the slides was stained by (H&E), The
Histopathological assessment for a celiac disease according to marsh classification, serum was
collected and antitissue transglutinmase IgA Antibodies measured by ELIZA.
Results: the histiopathological findings of second part duodenal biopsy as a following 8(16%) cases
with Marsh I( intraepithelial lymphocytes infiltration), 10 (20%) cases with Marsh II (intraepithelial
lymphocytes infiltration +crypt hyperplasia),16 (32%) cases Marsh IIIA (intraepithelial lymphocytes
infiltration +crypt hyperplasia+ partial villous atrophy), 10 (20%) cases with Marsh IIIB (intraepithelial
lymphocyte+crypt hyperplasia+ subtotal villous atrophy) 6 (12%) cases with Marsh
IIIC(intraepithelial lymphocytes +crypt hyperplasia +total villous atrophy).
Conclusion: In the present study the serum level of anti-tissue transglutinmase IgA anti body was
higher in celiac with severe entropathy (Marsh IIIb-c) than in those with slight entropathy (Marsh IIIIa),
so the serological tests with high level>100 IU/ml reveal in celiac disease while low serological
test need histophalogical assessment to avoid underestimate the real prevalence of celiac disease

This study is aimed to measure the serum levels of Zn and Cu in BTM patients with respect to their
iron overload, and methods of treatment. A total of 81 BTM patients were enrolled in the study among
them 12 patients were just diagnosed and received no treatment to serve as a second control group
beside the first one which was composed of the healthy subjects. Patients on scheduled blood
transfusions and those on subcutaneous (Sc.) Desferrioxamine (DFO) infusions beside blood
transfusion were compared firstly with the healthy controls and secondly with the newly diagnosed
thalassemics. A third type of comparisons was done among the study groups themselves. The results
showed that in comparing the patients on blood transfusion with the healthy controls, a highly
significant increase in Cu serum levels (p‹0.01) were found. Comparison of the patients on DFO
infusions with the healthy controls showed a highly significant increase in serum Cu (p‹0.01), and a
significant decreases in Zn serum levels (p‹0.05). In comparing the spleenectomized patients with the
healthy controls a highly significant decrease were found in Zn serum levels (p‹0.01), and a significant
increase in Cu serum levels (p‹0.05), and so did the non spleenectomized patients.. In comparing the
newly diagnosed thalassemic patients with the healthy controls, a highly significant increase was found
in Cu serum levels (p‹0.01), no significant correlation was found between serum levels of ferritin and
either Zn or Cu. From this study it was concluded that treatment methods can significantly affect serum
levels of both Zn and Cu.

Out of the 300 urine samples, only 47(15.7%) isolates were identified as Escherichia coli. The
hemolysin produced by E.coli was studied, and it was found that 19(40.4%) out of the 47 isolates of
E.coli were able to produce hemolysin extracellularly on human and rabbit blood agar. Hemolysin
extraction was done and five hemolysin filtrates were subjected to purification, which was treated with
ammonium sulfate to obtain 20-40% saturation in phosphate buffer (0.05 M, pH: 6.8). It was found that
all of these filtrates contained hemolytic activity at a level higher than that before purification.
Immobilization of both hemolysin producing bacteria and free purified hemolysin was also done. It was
seen that immobilization by sodium alginate had no effect on hemolysin productivity and activity and
the immobilized hemolysin retained its activity after re-using twice or more on blood agar. The effect
of purified hemolysin on WBCs in human blood samples and urine blood samples was also studied. It
was seen that there were significant effects of hemolysin samples on WBCs count which caused
reduction in the number of these cells in both blood samples and in urine samples.

Background: Itch can be defined subjectively as a poorly localized, non-adapting, usually unpleasant
sensation which elicits a desire to scratch . Although specialized nerve endings have been identified for
a wide range of stimuli no specific receptor has been identified for itch and it is generally agreed that
itch (and pain) are received by unspecialized free nerve endings located close to the dermo-epidermal
junction. Generalized severe pruritus occurs in about (30-50 %) of renal failure cases, its one of the
dermatological diseases that is difficult to control. Unfortunately, haemodialysis can initiate the
symptom as well as improve it. Up to 85% of patients on haemodialysis suffer from itching. Many
modalities of treatment are found for those patients, as topical emollients, phototherapy, antihistamine.
Aim of study: To assess the effectiveness and safety of gabapentin in treatment of pruritus induced by
dialysis.
Method: This study was conducted in Merjan teaching hospital Haemodialysis unite .23 patients were
included in this study (13 male and 10 female , age more than 18 years) . Haemodialysis was
performed twice times per week. All patients had histories of pruritus of more than 6 weeks duration
that does not respond to antihistamines and other topical treatments . Any medication with presumed
antipruritic effects was discontinued one week before the study. The patients were asked to record the
severity of their pruritus on a visual analogue scale twice weekly (at dialysis time). The scale consisted
of a 10 cm horizontal line marked from 0 (denoting no itch ) to 10 (denoting worst possible imaginable
itch). Patients were assigned to receive 4 weeks of gabapentine therapy followed by 4 weeks of placebo
and there was a 2 weeks of washout period between the sequential treatment phases. Gabapentine
100mg or placebo was administered orally twice weekly at the end of haemodialysis sessions.
Result: The mean pruritus score before the treatment was 8.43 ± 0.99 with a range from (7-10), after
gabapentin therapy the score decreased to 1.26 ± 1 (range : 0-3 ; p-value < 0.0001) while after the end
of the resting two weeks (interval period) the score increased to 7.56± 1.55 , increment continued to the
end of placebo period (after one month) reached to 8.1 ± 1.01 (range : 6-10 ; p-value = 0.1686).
Conclusion: Gabapentin is a safe and effective drug in treatment of pruritus induced by dialysis with
little side effects.

This study was conducted to estimate the expression of her2/neu oncoprotein in human colorectal
carcinoma and to show its possible correlation to the pathological parameters. Thirty five patients of
colorectal carcinoma were studied in Al- Diwanyia teaching hospital and some private hospital in a
period from January 2007 to Juan 2010 , out of 35 cases there were only 20cases positive for her2/neu
oncoprotein. The rate of her2 was high in colorectal carcinoma and the important feature of her2/neu
expression was the membranous-cytoplasmic pattern , it was prominent in Grade III ,and stages C and
D , so this pattern indicates poor prognosis of the tumor.

Background :- Colorectal cancer is the second most prevalent cancer and the fourth leading cause of
death[1]. In Iraq and according to the Iraqi cancer registry reports in 2002 , the incidence of colorectal
carcinoma was 4.55% of whole body malignancy, & it is the seventh cause of death from cancer[3].
Immunohistochemical studies have revealed that CEA is a product of normal as well as cancerous
colonic cell and that the difference in CEA content between the cancerous and the normal colorectal
mucosa is quantitative and not qualitative[9-11], Expression of bcl-2 has been studied in a number of
human tumors, including colorectal carcinoma. Non-small-cell lung carcinomas[18] breast
carcinomas[19,20] and neuroblastomas[21] all express bcl-2, and studies have been published
correlating expression with survival. Similarly, a number of studies[22-26] have been published
evaluating the clinical use of bcl-2 immunohistochemical expression as a prognostic factor.
Aim of the study :- The aim of our study was to estimate possible correlations between the CEA and
BCL-2 immunohistochemical expression and some pathological parameters in colorectal
adenocarcinoma like grade , stages and site of tumor
Material and method: - thirty nine patients of colorectal carcinoma studied in Al- Diwanyia teaching
hospital during a three years period (July 2008 - December 2010) were studied. There were 30 males
and 9 females with a median age of 58 years (range 26-90 years). A manual avidine-biotin-peroxidase
complex procedure was used in the immunohistochemical analysis (DakoCytomation, Copenhagen,
Denmark).
Result :- all the studied cases were positive for CEA (100%) and out of 39 cases there were only
23(58.9%) cases positive for BCL2 expression , also this study showed significant relationship between
expression of CEA and grades and site of tumor while BCL2 significantly correlated with grades and
stages of the tumor.
Conclusion :- From the present study we may conclude that CEA and BCL-2 have a similar pattern of
expression in primary colorectal adenocarcinoma although BCL-2 expression in colorectal
adenocarcinoma is more restricted than CEA expression

Background: Gastro esophageal reflux disease (GERD) is a common entity worldwide including Iraq,
where by 8% of normal population described typical symptoms of GERD. About 14% of patients with
dyspepsia referred for upper GI endoscopy were found to have GERD. It is associated with
complications including higher incidence of lower esophageal adenocarcinoma. Many studies have
clearly demonstrated that this risk is directly related to the occurrence of IM in the lower esophagus socalled
(Barrett esophagus) because of injurious effect of regurgitated acid peptic secretion over a long
duration the squamous epithelium become replaced by columnar epithelium which is more resistant for
acidic content of gastric juice and serve as a protection for the lower esophagus. Mucin histochemistry
has been found a useful method to define type and distribution of glycoprotein in the GIT, and thus to
define GERD patients at risk of neoplasia.
Aims of the study:
1- To show the histopathological changes of lower esophagus and GEJ in patients with GERD.
2- To study the mucin histochemical changes in GEJ and lower esophagus and tackle the
controversy concerning the nature and significance of mucin profile in this area.
Patients and methods: The study was conducted on 30 patients suffering from symptoms suggestive
of GERD as study group, with additional 10 patients taken as a control group who suffered from
symptom other than GERD. Endoscopic biopsies were taken from GEJ and lower esophagus about 2
cm proximal to GEJ. The histopathological features of all cases were reviewed with emphasize on
squamous epithelial changes (including intra epithelial eosinophiles , basal cell hyperplasia > 20% of
mucosal thickness , papillary elongation > 70% of mucosal thickness) and metaplastic , dysplastic and
carcinomatous changes. PAS diastase and combined alcian blue-aldehyde fuchsin stains were used to
detect Mucin histochemical changes in the studied groups.
Results: Our study revealed the presence of intra epithelial eosinophiles with basal cell hyperplasia >
20% of mucosal thickness were significantly associated with GERD in 70% of patients. By using
special Mucin stains incomplete IM type IIB was found in 5 patients (16.7%) with GERD.
Conclusions: Basal cell hyperplasia and intraepithelial eosinophiles are frequent histological findings
in biopsies of patients with GERD. Mucin histochemistry is a useful method to define IM in esophageal
and junctional biopsies. However the presence of IM type IIB does not correlate with the severity of
endoscopic findings in GERD.
Key wards: GERF. Gastroesophageal reflux disease, intra epithelial eosinophiles, basal cell
hyperplasia

Hyperkalaemia is a commonly encountered problem in dialysis patients with end-stage renal disease
(ESRD) this might lead to increase corrected QT (QTc) duration which could have serous
consequences. The aim of this study is to assess the effect of serum electrolyte imbalance mainly
Potassium causing ECG changes such as QTc during haemodialysis (HD). Prospectively, eighteen
haemodialysis patients with ESRD had ECG and serum electrolyte tested before and after HD. The
ECG parameters were measured manually, the QT interval was corrected to the heart rate, the data
were calculated and analysed with SPSS 17 software.
There were significant effects of HD on serum electrolytes and some ECG parameters; the pre-HD K+
was 5.24±0.87 mmol/L and post-HD was 3.93±0.69 mmol/L (P 0.007) and pre-HD Ca2+ was1.98±0.17
mmol/L and post-HD was 2.22±0.15 mmol/L (P 0.003). QTc interval pre-HD 431.3 ± 32.1 ms and
post-HD was 443.5 ± 32.4 ms (P 0.002). T wave pre-HD 4.33±1.89 mm and post-HD 3.18±1.11 mm
(P0.045). An abnormally prolonged QTc (>440 ms) was measured in 27.7% of cases pre-HD and was
recorded in 38.9% of cases in post-HD.
There was correlation between pre-HD K+ and pre-HD QTc interval (r 0.699, P 0.001), and negative
influence of the net change of K+ on the amplitude difference of T wave during haemodialysis (r -
0.422, P 05). No other influence of serum electrolyte imbalance on ECG changes was noted.
Significant changes in serum electrolyte changes and ECG parameters during haemodialysis. There
was limited association between serum electrolyte and ECG parameter changes during haemodialysis.

Breast cancer is the most common cancer affecting women in the united states. Now it is ( 1 in
8 ). Breast cancer is 2nd most common cancer in women it affect ( 1 in 11 ) in the united kingdom.
Early detection is the only way to control the disease. Seven reported cases of women with carcinoma
of the breast stage 1 and 2 were studied. 5 patients had right breast cancer and 2 patients had left breast
cancer.
The age group was between 40 – 55 years. All patients proved to be carcinoma of the breast
which was treated by mastectomy with postoperative radiation and/ or cytotoxic drugs or hormonal
therapy. 2 patients were treated by oopherectomy as well. The 10 years survival rates were very good.
All patients were alive followed up by the surgeon regularly.
After 13-17 years those patients were referred to me by the surgeon because of postmenopausal
bleeding. Proper examination and investigations and by surgical management we found that 4 patients
had benign endometrial polyps and 3 patients had endometrial carcinoma which were treated by
polypectomy and hysterectomy with or without cytotoxic or hormonal therapy.
We conclude that there are close relationship between carcinoma of the breast and endometrial
carcinoma mainly in susceptible women, even after many years.
Aim of study:
To study more about the most important causes which initiate any tumor in the human body , whether
benign or malignant . Then to know much about the incidence of two primary tumors affecting
different organs of the same person even after many years. From the previous tumor excision or
removal.

Background: Arteriovenous fistula (AVF) formation is an uncommon clinical manifestation of
arterial trauma. A delayed diagnosis of AVF of 15 years had been reported, underscoring the potential
for missing these injuries.
Patient Presentation: A fifty years old male presented with left lower limb heaviness and pain
associated with leg swelling, color changes, ulcerations and offensive discharge with physical signs of
traumatic AVF at site of previous trauma and vascular exploration
Results: Successful surgical repair of long standing left sided traumatic femoro-femoral fistula.
Conclusion: In long standing traumatic AVF, the final surgical procedure undertaken will ultimately
be determined by peroperative findings whatever the initial preoperative plan was.

Objectives: To assess usefulness of argyrophilic nucleolar organizer regions (AgNORs) in
distinguishing between the benign and the malignant breast lesions.
Study design: The studied samples included 48 formalin-fixed, paraffin-embedded breast tissues
which consist of following diagnostic categories: Adenosis (n=8), ductal hyperplasia (n=6), infiltrative
ductal carcinomas (n=14), infiltrative lobular carcinomas (n=5), and ductal carcinomas in situ (n=5).
Standardized AgNORs analysis was performed on the above mentioned samples according to the guide
lines of the committee on AgNORs. Quantification of AgNOR content was done by the usual
counting method.
Results: The mean AgNORs counts of these studied cases were as follow : Adenosis 2.59+/-0.54,
ductal hyperplasia 3.15+/-0.54, benign cysts 1.7+/-0.42, phylloides tumor 4.2+/-1.18, infiltrative ductal
carcinomas 8.92+/-1.68, infiltrative lobular carcinomas 8.79+/-1.11and ductal carcinomas in situ
8.84+/-2.54. The differences in mean AgNORs counts between benign (2.58) and that of malignant
lesions (8.84) were statistically significant (p-value 0.001).
Conclusions: The use of AgNORs analysis is found to be a helpful tool in addition to the
conventional hematoxylin and eosin staining technique for the distinction between benign and
malignant breast lesions

Objective: Complications of D.M. affect many organ systems and are responsible for majority of
morbidity and mortality associated with this disease. Pulmonary complications of D.M have been
poorly characterized, although some authors had reported normal pulmonary function, others found
abnormalities in lung volumes, pulmonary mechanics, and diffusing capacity.
Material and Methods: Fifty patients with Diabetes mellitus (DM) were included in this study that had been
conducted at Al-Sader teaching hospital in Al-Najaf, 17 had DM type 1 (9 males and 8 females), and 33
patients had DM type 2( 19 male and 14 female), 20 age and sex matched person were included as a control
group (11 were male and 9 female). Spirometric tests were done for the two groups by flowmeter and
computerized Spirometry with six parameters {(Vital capacity (VC ), Forced vital capacity (FVC ),
Force expiratory volume in first second (FEV1 ) , Force expiratory volume in first second percent
(FEV1% ) , Force expiratory volume in first second to force volume capacity (FEV1/FVC ) ,and Peak
expiratory flow rate (FEFR)} .
Results: Spirometric tests were found to be significantly lower in the first (Diabetic )as compared to
nondiabetic.Sex and duration of DM were not associated with any of the parameter that were considered, the
duration of DM was recorded to affect the Spirometric tests , however these differences were not significant
statistically. Type 1 diabetics had more significant deterioration of Spirometric results as compared to type 2
DM.
Conclusion: Spirometric results were lower in diabetics as compared to nondiabetic, and type 1 had more
frequent and severe disturbance in Spirometric tests as compared to type 2, on the other hand, sex and
duration had no significant effect on Spirometric tests in both types.

Objectives: This study aimed to evaluate the effect of low level laser therapy (biostimulation) using
the diode laser with wavelength of (790-805) nm in promotion and enhancement of wound healing of
episiotomy.
Women, materials and methods: thirty women (22 of them were primipara) with episiotomy wound
were selected and divided into three groups, 1st group (group No.1: control group) given antibiotics
without laser therapy, in the 2nd group (group No.2) the wound exposed to laser therapy (4 sessions,
each session with energy density 8 joule /cm2 every other day ) and antibiotics for 1 week, and in the
3rd group (group No.3) the wounds were exposed to laser therapy (4 sessions, the same as in the 2nd
group) but without antibiotics.
Results: Those patients who exposed to LLLT showed significant reduction in the level of pain and
tenderness after the 1st laser exposure, and rapid healing process that occur within seven (7) days, and
the results were about to be equal in both (group II & group III), while group I showed prolonged
period of healing (9-11) days with moderate to severe pain and tenderness that interfered with their
sitting and walking and one case ended with dehiscent wound.
Conclusions: LLLT can be used to enhance surgical wound healing, & to induce analgesic effects if
proper wavelength, energy density and exposure time are selected.

Background: The central pathogenic mechanism in NSAID-induced gastro-duodenal toxicity lies in
their ability to inhibit the synthesis of prostaglandins by gastric mucosa through inhibition of cyclooxygenase
enzyme (Cox). There are two isoforms of Cox enzyme: Cox-1 and Cox-2. The gastroprotective
effects of prostaglandins are mediated by Cox-1 while the inflammatory effects are mediated
by Cox-2. NSAIDs inhibit synthesis of prostaglandins, resulting in toxic effects on gastric mucosa and
beneficial anti-inflammatory effects.
Conventional NSAID are non-selective inhibitors of cyclo-oxygenase and thus, they promote the antiinflammatory
response and at the same time inhibit gastric protective effects of prostaglandins. To
overcome this problem, drugs that have little or no Cox-1 inhibitory activity have been developed and a
new generation of NSAIDs has emerged.
Aim of the study: The aim of this study is to evaluate the morphological effects of Rofecoxib on the
gastric mucosa by comparing them with those produced by Aspirin and Indomethacin.
Material and Methods: 40 Spargue-Dawely rats were used in this study. The animals were divided
into four subgroups, each group included ten animals. Group I received no treatment and considered as
control, group II received Aspirin, group III received Indomethcine, and group IV received Rofecoxib.
After one month of treatment the animals were sacrificed and the gastric mucosa in each animal was
examined macroscopically and microscopically.
Results: Aspirin produced the most sever gastric lesions mainly in the pylorus, which take the form of
erosions and ulcerations. Rofecoxib caused the least gastric lesions mainly in the body of the stomach.
Indomethacin caused an intermediate degree of gastric damage mainly in the body of the stomach.
Conclusion: Aspirin and Indomethacine produced the most sever effect on gastric mucosa, these
effects take the form of gastric erosion and ulceration that involved mainly the pylorus and the body of
the stomach respectively. Rofecoxib, showed the least gastric lesion as compared to Aspirin and
Indomethacin.

Background: Exercise testing is useful in the assessment of presence of coronary arterial disease , the
Duke's treadmill score is a composite index that was designed to provide survival estimates based on
results from the exercise test, including ST-segment depression, chest pain, and exercise duration.
Objectives : the objectives of this study were to correlate the angiographic findings of the patients
with Duke's score and adding other parameters like risks factors and type of ST deviation to increase
it's accuracy.
Setting : Merjan teaching hospital and Shahid Almihrab cardiac centre.
Methods :Across sectional study done on hundred patients whom underwant exercise treadmill test
with calculation of Duke's score followed by coronary angiograph that was correlated with Duke's
score and other parameter added to it.
Results : By comparing the result of exercise treadmill test and Duke's score with the result of
coronary angiography it showed that in the low risk Duke's group, the coronary angiographic results
were mainly normal (40%) or single vessel disease (40%) and rarely showed two (10%) or three
vessels disease(10%) and no left main stem disease was found. For the intermediate Duke's risk group
the coronary angiographic results distributed on the normal (22.2%), single (30.2%), two (25.4%), and
three vessels disease (19%) while it was rarely showed left main stem disease (3.2%). For high Duke's
risk group the coronary angiographic results showed mainly three vessels disease (40.8%) and left main
stem disease (37%), while it showed two vessels disease in 18.5% and rarely showed single vessel
disease (3.7%) and no normal vessel were shown, The P value for this relation was <0.001. For
intermediate Duke's risk group adding of patient's risk factors and the type of ST deviation were
statistically significant in predict coronary lesion with P value 0.001, 0.028 respectively.
Conclusion : Duke's score can predict coronary lesion and adding of patient's risk factors and type of
ST deviation can increase it's ability to predict coronary lesion.

Background: Magnetic resonances imaging (MRI) is reliable in evaluation of lumbar disc
degeneration, however there is a variation in grading of degeneration. Aim of the study is to measure
observer variability in assessing degeneration using a grading system.
Patients and methods: Tow radiologist assessed degeneration of 150 lumbar discs of 30 patients (21
male & 9 female) by evaluating MRI examinations, using a grading system after some modifications
in nomenclature. Intraobserver and interobserver agreements were measured using weighted Kappa
statistic.
Results: Intraobserver agreement ranged from moderate (kappa of 0.55) to very good (kappa of 0.87)
while interobserver agreement ranged from moderate (Kappa 0.46) to good (kappa of 0.76). Main
disagreement were between severe and moderate grads of degeneration while best consensus was
obtained in normal discs.
Conclusion: Moderate to very good agreement obtained in application of our grading system.
Disagreement may be reduced by proper and more frequent use & increasing familiarity. However,
further studies with larger sample and among more observers may be still required for the system to be
practically applicable.