Medical Journal of Babylon

Background: Perforated peptic ulcer disease was rare in the 19th century but demonstrated a rise with the start of the 20th century. There had been a change in the treatment of perforated peptic ulcer disease from simple suturing to vagotomy and later to gastrectomy and finally the return to simple suturing combined with eradication treatment for H pylori. After the discovery of proton pump inhibitors (PPI), the incidence of peptic ulcer disease (PUD) seems to be decreasing but perforated peptic ulcer disease remains either stable or increased. The objective of the study was to identify risk factors for mortality and morbidity following the event of perforated PUD and ways to avoid them.
Methods: 34 patients with perforated duodenal ulcers in the emergency department of Al-Hilla Teaching Hospital who had been treated surgically by Graham patch followed by eradication treatment of H pylori between the 1st of March 2008 and the 5th of January 2012 had been studied prospectively recording intra and postoperative mortality and morbidity, history of smoking, non steroidal anti inflammatory analgesics (NSAIA), history of dyspepsia and the risk factors for the complications.
Results: Males constituted 21(61.7%) of our 34 patients. NSAIA and smoking were recorded in 12(35.3%) and 17(50%) of the patients respectively. 26 ( 76.4%) of the patients had been discovered to have duodenal ulcer (DU) for the 1st time with no previous history. 31(91.2%) of the patients had air under the diaphragm on chest x ray in standing position. 10(29.4 %) of the patients presented early to hospital ( within one day of abdominal pain ) while 21(61.8%) presented late and 3(8.8%) very late. Most of the patients recovered completely postoperatively without complications. 3(8.8%) had leaks from the repair and unfortunate death happened in only one (3%). 21(61.7%) had been referred from a general practitioner or another specialty of medicine before coming to the surgical department and a delay of more than 24 hours happened in 15 of these patients.
Conclusion: Perforated duodenal ulcer is a potentially-fatal disease that has to be dealt with abruptly once diagnosed. Care must be taken to prevent the complications especially in those who are elderly or have a comorbid illness as these are the people at risk. Delay in the diagnosis usually happens in the peripheral hospitals and by medical specializations other than surgery

In this study 298 patients suffering from diabetes mellitus type 2 (150 male, and 148 female) aged between 35 to 67 years with a mean age of (45.11±12.03) were included. The study was carried out from first of November 2009 to the day 31 of May 2010.The samples were obtained from Al-Kassim hospital and Merjan Teaching Hospital in Hilla city . The study included three groups:
Firstly: 149 patients with type 2 diabetes mellitus treatment with Daonil . Secondly: 149 patients with type 2 diabetes mellitus treatment with Glucophage .Thirdly: 83 apparently healthy subjects were chosen as healthy people.
The results show a significant increase p<0.05 in Acetylcholinesterase AChE activity of patients treated with daonil and glocophage ≤5 years when compared with control group , while AChE activity found to be highly significant increase p<0.001 in patients treated more than five years when compared with ≤5 years and control groups. No differences were found in blood AChE activities between subgroups of each sample used in this study .
Corrected total calcium and ionized concentrations in DM type 2 treated with daonil and glucophage groups ≤5 and more than five years found to were highly significantly increased p<0.001,when compared with that of the control, while there was a non-significant difference p>0.05 between the males and females when compared in the same group( control, daonil and glucophage ) in all duration. A significantly increased p<0.001 in the corrected total calcium concentration of DM patients treatment with daonil (more than five years) when compared with that of the patients treatment with glucophage .
A significant increase p<0.05 in magnesium concentrations in diabetes mellitus patients (daonil, and glucophage) ≤5 years when compared to control group. On the other hand a highly significant increase p<0.001 of magnesium concentrations were found in sera of DM patients more than five years when compared to DM patients ≤5 years and control group .No significant difference were found between males and females in control group and patients groups.
A significant decreased p<0.05 in total antioxidant(TAC) concentration in DM patients treatment ≤5 years with daonil and glucophage was found when compared with control groups .A highly significant increase of total antioxidant p<0.001 in sera of TCA of DM type 2 patients treated (6-15y) when compared with that of healthy control group and ≤5 years. No significant difference was found in the males and females of DM type 2 patients treated with daonil and glucophage (≤5y or 6-15 y) when compared with control group P>0.05.

Back ground and study objectives: This is paramyxovirus infection and is endemic world-wide. It is probably the most infectious of all microbial agents. Before immunization campaigns, measles occurred in almost 100% of children. In temperate areas there is a natural epidemic cycle every 2-3 years. Natural illness produces life-long immunity.
Patient and methods:50 cases of measles that admitted to the Marjan teaching hospital , between 1/1 – 1/10 2008 were included , all of them at adult age ( mean age 21 years )and clinical evaluation had been done on these cases in addition to study of its distribution on both sex ,age distribution ,geographical distribution ,effect of vaccination on occurrence of this infection , the most common symptoms and signs and complications that occurred during the course of the disease , also effect of this virus infection on some haematological and biochemical investigation .We compared the result of some of these data with previous years inpatient data on the same hospital . the patients were followed for an average of 10 day .
Aim of study:The aim is to evaluate the occurrence of this viral infection on adult hood age group in Babyllon province that were admitted to Marjan teaching hospital isolation rooms and to study the most important clinical presentation and complication on this age group and to evaluate the clinical behaviors of this virus on this age group.
Results and conclusion: It was noticed that the occurrence of this virus is changing on the adult hood age with most serious reported complication had been noticed on this age group , 50 cases were collected and it is more in female at this age group than male , and the age between 21-26 years are the most common age affected(26 patients ) 52% , the center of Alhilla had more cases than other peripheral areas , non vaccinated peoples are more than the vaccinated one , the hottest month ( July) show the peak admition rate of cases of measles , conjectivitis is the most common complication and pneumonia is the most serious one with high mortality

Beta-thalassemia is a hemolytic anemia of genetic origin, it results from a decreased or absent synthesis of beta globin chains that normally constitute a part of the adult hemoglobin (HbA, which is α2β2). This genetic defect will lead to a compensatory ineffective erythropoiesis, severe anemia, and increased erythrocytes turnover. Thalassemia syndrome is usually accompanied by a wide spectrum of complications arising from the disease itself as well as the methods used to alleviate it.
This study aims to investigate the presence of renal dysfunctions in children and adolescent with transfusion dependent (TD) βT, without any overt renal diseases, using both conventional and early markers of glomerular and tubular dysfunctions this will help the medical staff for proper management with less morbidity and mortality.
This study were lasted from (February till September/ 2011) conducted in the Heriditary Bleeding Disorders Center in Hilla city, on (Eighty one) β-thalassemic patients who enrolled in this work and control group include (twenty) apparently healthy subjects. Patients in this study were divided in to three groups according to the age : group І was(3-10)years, group Π was(11-18)years and group ΠІ was(19-25)years and healthy subjects with an age range (3-25) years.
Result shows significant increase of serum creatinine, serum urea and serum uric acid in patient groups compared with control group (p˂0.05). However, significant increase was observed in group ΠІ than those of group І as comparison between the patient groups (p˂0.05).
The present study found that urinary NAG were highly significant increase of NAG in urine samples of Patients groups in comparison with control group at (p˂0.01) , this increment will be concomitantly with aging of age group(p˂0.05). As it appear as early detection markers of tubular damage.
Lastly hematuria in all of patient studied groups were 22 (27.5%), pyurea were28 (34%) and protein urea were 20(24.69%) demonstrated that in patients with beta thalassemia, hematuria is more common in older age groups. Furthermore, protein urea and pyurea seems to be a common accompanying finding in patients with beta-thalassemia.
The changes in data that showed in this study with β-thalassemia patients may refer to a multiple renal abnormalities with progression of the age and that’s may be due to multiple blood transfusion, iron overload or chelation therapy.

Eighty-five blood samples were obtained from pneumonic infants below 6 months age admitted to Child and Maternal Hospital at Hilla City. The results revealed that 46:85[54.1%] gave positive blood culture whereas 39:85 [45.9%] gave no growth. Gram positive bacteria were the predominant types in comparison to gram-negative bacteria. Staphylococcus aureus, Staphylococcus epidermidis and Corynebacteriam accordingly were the predominant bacterial causative agent isolated during this work, while Escherichia coli, Pseudomonas aeuginosa were predominant Gram-negative bacterial isolates. E-rosette test showed a mean of subnormal value [13.3%, 20% and 12%] for pneumonic infants infected with Staphylococci, Corynebacteria, and Gram-negative bacteria respectively. IgG levels were higher [518.9 mg/dl] in pneumonic infants when compared to normal value, likewise the means of IgA [101.2 mg/dl] and IgM [99 mg/dl] were within the normal range.

In this study, wound swabs and blood samples were collected from (100) patients suffering from burn wound infections with the age range between (1.5-45) years old from both sexes. The period of collection were extended from November 2011 through March 2012.
All samples were subjected to identified the bacterial cultivation, and different types of bacteria were isolated which caused burn wounds infections. The predominant bacteria was P.aerugenusa for gram negative, and for gram positive was S.aureus.
Biofilm formation were studied for all bacterial isolates and the results shown that The most bacteria that form biofilm were A.baumannii and Enterobacter spp. (80%) where as lawest one was K. pneumoniae (20%).

Background: Carpal tunnel syndrome is the commonest and the most important entrapment neuropathy that affects median nerve at wrist region more commonly in middle age females, resulting in certain sensory and/or motor dysfunction of median nerve.
Patients and methods: 40 patients with a carpal tunnel syndrome were individually randomized into the trial (mini-open incision CTR) (n=20) and control group (classical technique CTR) (n=20). We followed up the patients of 2 groups for period of 6 months, observation has been done at third week , third month and 6month postoperatively, the patients were asked about symptomatic pain relief and functional status of the hand (including pinch and grip functional activities ) and scored according to Boston Carpal Tunnel Questionnaire (BCTQ) score , and examined for palmar tenderness, esthetic outcome of scar and operation time were measure
Results:
1) The mean symptom severity scores of BCTQ in both group decreased (improved) significantly within 3 weeks postoperatively.
2) The mean functional status scores of BCTQ is decrease earlier (in third month postoperatively ) in the trial group where the difference is significant , where as at sixth month the difference in mean of 2 group become not significant statistically.
3) The operation time is shorter in trial group.
4) The esthetic outcome and pillar tenderness is significantly better in trial group.
Conclusion
1) mini-open technique is associated with significant minimal scar tenderness, esthetic outcome, significant improvements in overall hand function and shorter in operation time than classical technique.
2) The symptoms ( pain, numbness and parasthesia) in both mini-open technique and classical technique will relief early and significantly within 3weeks postoperatively.
3) The mini-open carpal tunnel release via a small palmar incision is a relatively simple and effective procedure
Keyword
CTS, mini-open CTR technique, classical CTR technique, Boston Carpal Tunnel Questionnaire (BCTQ) score

Background :Adenoidectomy is the surgical procedure to remove the adenoids. It is conventionally performed using the curettage method.
The aim : is to compare between conventional and endoscopic –assisted method regarding safety and efficiency.
Patients and methods : from September 2010 to October 2011 , 40 patients (16 males and 24 females), requiring adenoidectomy were randomized into two groups each of twenty. Group A underwent conventional adenoidectomy using the curettage method and Group B underwent trans-nasal endoscopic adenoidectomy using microdebrider.
The parameters studied were intra-operative time ,complete resection ,associated trauma, ,velopharyngeal dysfunction , ,residual remnant ,post-operative bleeding ,infection , and post-operative symptomatic relief.
Exclusion criteria include : post-operative pain and the amount of blood loss because the majority of patients underwent additional tonsillectomy. Telephone questionnaire was used to follow up any symptomatic recurrence .
Results : After a short period of follow –up ,the time taken in Group A (conventional surgery) varied from 10-35 minutes [with a mean= 32.25 minutes ]( 95% CI 20.004-26.496) (P <0.001) and in Group B (endoscopic method) from 20-90 minutes [with a mean of 42.75 minutes] (95% CI 43.097-15.604) .The resection was almost complete in group B whereas in group A four cases (20%) had residual adenoid tissue(95% CI _0.3895-_ 0.0141)(P<0.035).associated trauma in Group A found in 3 cases (15%) all are minor involving the uvula and posterior pharyngeal wall whereas in Group B trauma occurs in 5 cases (25%),3 are minor involving septal mucosal injuries while 2 cases (10%) required nasal packing(P >0.05).
.Velopharngeal dysfunction developed in 2 cases (10%) of Group A and 3 cases(15%) of Group B ,all are resolved spontaneously within a week and not required any treatment (95% CI _0.0155-0.255)(P>0.05).Infection complicated 1 cases (5%) of Group A and 1 case of Group B(95% CI _0.1479-0.3479) (P>0.05) .Retained swab complicated 1 case (5%) of Group A whereas none in Group B.The overall complication rate in Group A was 55% whereas in Group B 45%.
Conclusion :Endoscopic –assisted Adenoidectomy is a safe and effective alternative to curettage method as it allow complete removal of adenoid tissue under direct vision .It is recommended to perform endoscopic –assisted surgery even with curettage method when possible.

Immune status was examined after tonsillectomy operations in 30 children with recurrent acute tonsillitis, their ages ranged between 3-10 years, were clinically diagnosed by ENT surgeon at Al- Hilla General Teaching Hospital and 10 apparently healthy children were included as a control in the study which lasted from February to May 2011 .Immunological parameters test were done directly postoperative by taking venous blood from the patients and control to determine the immunoglobulins of IgM, IgG, IgA, complement proteins C3 and C4 level in addition to C- reactive protein test were done as indicators of inflammation. It was shown that the immunological assays after tonsillectomy revealed positive changes: a significant increases in IgM and IgA levels in serum of patients in comparison to control although were still in normal reference values but serum IgG level and complement proteins C3 and C4 level were normal in addition to the results of CRP in patients giving positive results in comparison to controls

Back ground: Gastric hyperacidity and peptic ulcer are very common causes of human suffering. Although there are different types of antiulcer drugs still they are expensive and have many side effects.
Objective: To investigate the antiulcer activity of watery extracts of (liqurice and chamomile) and chamomile oil in rats models.
Material and methods: Liqurice (glycyrrhiza glabra) roots extraction by crushing and boiling, while chamomile extraction by hot water maceration and the yield were used after cooling. Antiulcer effects were evaluated in rats using ethanol and salicylic acid ulcer induced method.
Results: The aqueous extract of chamomile and liqurice and chamomile oil exhibited significant (p<0.05) anti-ulcer activity in this ulcer induced models compared with omeprazole as standard drug.
Discussion: The protection effects of these plants extracts may be due to its antioxidant contain and protective effect on the lining mucosa by enhancing the protection factors.

Abstract A retrospective study for 100 endometrial biopsies done during one year period (October 2010- October 2011), the chronic endometritis was the diagnosis in 50 cases of them while other 50 cases given another diagnoses (depending on routine hematoxylin & eosin stain). All the 100 cases stained by CD- 138 immunostain and the Immunohistochemical expression of this stain found in 52 cases out of 100 cases submitted for this stain, 44 cases out of those 52 cases were diagnosed as chronic endometritis by hematoxylin & eosin stain, while the remaining 8 cases which show CD – 138 positivity were diagnosed other than chronic endometritis by hematoxylin &eosin stain. So we can conclude that the detection of plasma cells and diagnosis of chronic endometritis become easier and more precise by using CD – 138 immunostain.

Background: Selective antihistamine receptor type 2 blockers like famotidine, ranitidine and cimetidine are widely used for treatment of peptic ulcer, and because many nonantibiotics agents have antibacterial activity.
Aims:This study aimed to evaluate the antibacterial effects of famotidine, ranitidine and cimetidine.
Material and methods: Tewnty two of bacterial isolates were selected and obtained from National Chemical Laboratory (NCL), from conjunctiva: 5 Staphylococcus aureus, 5 Escherichia coli,6 Pseudomonas aeruginosa and (6)Klebsiella pneumoniae. The drug's effects determined by Agar disc diffusion and Agar well diffusion methods,then evaluation done through measurment of zone of inhibition and minimal inhibitory concentration(MIC).
Results: Results showed that cimetidine and ranitidine have non significant and negligible antibacterial effects, while famotidine have significant antibacterial effects (P≤ 0.01) against Escherichia coli (MIC8mg/ml and inhibition zone 25mm) and moderately against Staphylococcus aureus.
Conclusions: famotidine have significant antibacterial activity especially against Escherichia coli.
Keyword: antibacterial, cimetidine, famotidine and ranitidine

Background: Ovarian response varies considerably among individuals and depends on various fators. Poor response in In Vitro Fertilization (IVF) yields lesser oocytes and is associated with poorer pregnancy perspective. Cycle cancellation due to poor response is frustrating for both clinicians and the patient.
Objective: This paper studies some ovarian reserve hormonal profiles which may be a contributing factor for poor ovarian response in Intra Cytoplasmic Injection (ICSI) cycles.
Design: A prospective controlled trial.
Setting: Fertility unit in Al- Sadar medical city, Najaf province.
Subjects and Methods: Eighteen poor responders to controlled ovarian hyperstimulation with gonadotropin have been withdrawn from 67 initially selected participants intended to undergo intracytoplasmic sperm injection as a treatment option for their infertility. Basal cycle day 2 hormonal levels for follicular stimulating hormone( FSH) ,Anti mullerian hormone ( AMH) and estradiol(E2) as well as antral follicular count( AFC) were measured and compared for both groups .
Results: The poor responder group found to be of higher age and basal serum FSH and lower basal serum AMH.
Conclusions: some markers of ovarian reserve may be used as a predictor of poor responders in assistedreproduction programme.
Key wards: Anti mullerian hormone (AMH), Folliclle stimulating hormone (FSH),Estradiol (e2) ,antral follicular count, Intracytoplasmic sperm injection (ICSI), Poor respoders.

Background: Nonorganic(functional)abdominal pain in children is common and similar in its presentation to many organic causes to the recurrent abdominal pain in children.
Patients and methods; These study was done on 100 children suffering from nonorganic (functional) abdominal pain in Al-Diwaniah province (in Iraq) and during one year (2010).Most of the patients have a strong family history of migraine, irritable bowel syndrome or both. Stress factors play an important role in provoking the symptoms in the patients, and removal of the stress factor is the main step in the treatment of this disease and leading to dramatic improvement of the pain. The stress factors were discovered easily by a short interview with child and his or her mother .
Results;Most of these stress factors were either from the brother or sister of the patient that were annoying the patients or from one of his or her colleagues in the school or from fear at night.

Objective: to compare the outcome of extracorporeal shock wave lithotripsy for renal stones with and without double J stent.
Patients and Methods: A comparative cross sectional study was carried out at the urological department of Al-Hilla teaching hospital from February 2011 to August 2011. Forty patients with renal stones measuring from (2cm_2.5cm) were selected for the treatment by extracorporeal shock wave lithotripsy (ESWL). All of these patients were adults with normal renal function and had unilateral radiopaque renal stones, no metabolic abnormalities, no symptomatic urinary tract infection. Children, renal failure and patients with lower caliceal stones were excluded from the study. They were divided in two groups of 20 each. Group A patients underwent ESWL without a double J stent and in group B a double J stent was placed before ESWL. Electrohydraulic lithotripter machine (PCK lithotripter, Turkey), was used to impart shock wave. 2000 shock wave were given in a session. Both the groups were compared for stone fragmentation, incomplete stone clearance, clinically insignificant stone fragment, steinstrasse, stone free rate, renal colic, fever, hemmaturia, dysuria, and number of ESWL session.
Result: Regarding stone fragmentation in group A (stentless), 19 patients had stone fragmentation from total number of patients of 20 which account 95% while in group B (stented), 18 patients develops stone fragmentation from total number of patients of 20 which account 90%. Incomplete stone clearance occurs in 4 (20%) patients without DJS and in 8 (40%) patients with DJS. Clinically insignificant stone fragments encounter in 3 (15%) patients in stentless group and also in 3 (15%) in stented group.
Steinstrasse developed in 1 (5%) patient without DJS and none in patients with DJS.
Stone free rate encounter in 11 (55%) patients in stentless group and 7 (35%) patients in stented group. Renal colic developed in 9 (45%) patients without DJS and in 3 (15%) patients with DJS. Hemmaturia encounter in 12 (60%) patients without DJS and in 15 (75%) with DJS.
Fever not encountered in patients without DJS and developed in 15 (75%) patients with DJS. Frequency developed in 2 (10%) patients without DJS and in 10 (50%) patients with DJS, while dysuria developed in 3 (15%) patients without DJS and in
10 (50%) patients with DJS.
Conclusion: pre ESWL double J stenting for 2-2.5 cm renal stone was not beneficial regarding stone fragmentation, stone clearance, steinstrasse and stone free rate, however renal colic was significantly less in stented group. Fever and lower urinary tract symptoms (LUTS) was significantly higher in stented patients

Breast cancer is the commonest malignancy in females and it has become a major health problem affecting women, worldwide.
Cancer cells are abnormal cells, grow and divide more quickly than healthy cells. Some cancer cells form growths called tumors. All tumors increase in size, but some tumors grow quickly, others slowly. Cancer cells can spread to other parts of the body through the blood and lymph systems, This is called metastasis.
The aim of the study is to find the percentage of multiparous patients and the so the effect of parity state on the incidence of breast cancer, then their ages at first pregnancy and number of their children
This study lasted from November/2010 to May / 2011.There were 100 patients. These patients were ranged from 26 to 75 years. Full detailed information were taken from the patients in regarding the state of parity ,age of patient at first pregnancy and the number of children .
Seventy five percent of our one hundred patients were multiparous and twenty five percent were nulliparous ,age of patients at first pregnancy were as 34.7% at age ≤ 20 year, 37.3% at the age group 21-25 years, 16% at the age group 26-30 years, 5.3% at age group 31-35 years and 6.7% at age group 36-40 years ,Those parous patients show 20% of them had 1-2 children , 44% had 3-4 children, 17.3% had 5-6 children, 13.3% had 7-8 children and 5.3% had > 8 children .
Breast cancer is a multifactorial disease with different parameters affecting its occurrence and then metastasis ,75% of patients were multiparous and high percentage of them were less than thirty years indicating poor out come ,while in regarding to the number of children in parous women , high percentage of patients were having higher parity rate .

Purpose: To evaluate the role of Gonadotropin (HCG) Hormone in bilateral and unilateral undescended testis in young and old age children, and its benefit for descent, with surgical out come results after therapy.
Material and Method: A prospective study on 117 patients (147 testis) with cryptorchidism, evaluated in AL-KUT general hospital from April 2005 to April 2009.Thirty of them with bilateral undescended (60 testis), and 87 patients with unilateral undescended testis,19 testis were impalpable and 128 testis were palpable. Patients divided into two group according to their age, from one years to five years 85 patients (110 testis) [25 bilateral (50 testis) and 60 unilateral], given 500 IU of HCG weekly intramuscularly for five weeks, and second group 32 patients (37testis) [5 bilateral(10 testis) and 27 unilateral] from five years to eight years, given1500 IU of HCG weekly intramuscularly for five weeks. Then patients were evaluated clinically, for descent and palpability. All patient not response to therapy and those with partial descent, orchiopexy done for them, and surgical out come results were evaluated.
Results: Descent occur more in bilateral undescended testis (33.3%) than unilateral group (10.3%), and more in younger age group (22.7%) than older age group (10.8%). We found that 5 testis (26.3%) were palpable from 19 impalpable testis, all of them young age group, while 50 low canalicular palpable testis become prescrotal (39%). We achieve success rate of 19.7% dropped after one year to (10%) due to relapse in 15 testis. The surgical out come was objective as easily descent to scrotum with short time of manipulation due to long spermatic cord with easily hernial sac isolation.
Conclusion: HCG treatment should be limited to those young children with bilateral low undescended testes and as combination therapy with surgery to facilitate surgical descent, otherwise HCG treatment in older age will delay the operative procedure.

This study was performed to evaluate the influence of simultaneous administration of aqueous green tea extract (1.5 %) with methotrexate (0.5 mg /kg) on the status of glutathione (GSH) in liver tissue, with measuring the activity of serum liver enzymes [alanine aminotransferase (ALT), aspartate aminotransferase (AST)] and serum bilirubin levels. Administrations of aqueous green tea extract alone resulted in a significant increase in liver tissue GSH level and when it was used with MTX it ameliorated MTX-induced changes in level of this parameter. Regarding enzymes activities, administration of aqueous green tea extract resulted in an alleviating effect on MTX-induced elevation in serum ALT activity with a non-significant reduction in serum AST activity; it also significantly reduced MTX-induced elevation in total serum bilirubin level, these effects may be related to direct or indirect antioxidant property of green tea extract .

Background: Pre-eclampsiaisa medical condition characterized by a BP of 140/90 mm Hg or greater after 20 weeks' gestation in a women with previously normal BP and who have proteinuria (≥ 0.3 g protein in 24-h urine specimen).
Aim of the study: In this study, we tried to establish the relationship between insulin resistance and oxidative stress in sera of pre-eclamptic women and their effect on the clinical severity of disease.
Patients and Methods: The study was conducted in Babylon Maternity and Pediatric Teaching Hospital for the period starting from April 2011 to the end of August 2011 on the fifty pre-eclamptic women [fifteen in the second trimester (G1), twenty in the third trimester (G2) with mild pre-eclampsia and fifteen patients in the third trimester with severe pre-eclampsia (G3)] .Fasting serum insulin, Fasting blood glucose , Total antioxidant level ,Lipid profile ,Malondialdehyde and uric acid were determined .Insulin resistance was calculated according to HOMA score. The results were compared with results obtained from age and BMI matched control group which con i ted of forty apparently healthy pregnant women [fifteen in the second trimester (G4) and twenty five women in the third trimester (G5)].
Results:The results of the present study revealed a significant increment in insulin resistance (IR-HOMA) in sera of (G1) compared with (G4) (P<0.05), also there was a significant increment in IR-HOMA in sera of (G2&G3) compared with control group (G5) (P<0.01),and also there was a significant increment in IR-HOMA in (G3) group compared with (G2) (P<0.01) . Serum total antioxidant status (TAS) was significantly declined in (G1,G2&G3) compared with (G4&G5) (p<0.01) and there was a significant declined in TAS seen in sera of (G3) compared with (G2) (P<0.05). Serum MDA concentration was significantly increased in (G1,G2and G3) compared to (G4 and G5) (P<0.01). Also serum MDA concentration was significantly higher in (G3) compared with (G2) (p<0.05) . S.uric acid concentration was significantly higher in (G1&G2 ) compared to (G4 and G5) (P<0.05). Also S. uric acid concentration was significantly increased in (G3) compared with (G5) (p<0.01) , and also s.uric acid was significantly higher in (G3) compared with (G2) (p <0.05). Serum TG & VLDL-c were significantly higher in (G1&G2) compared with (G4,G5) (p<0.05). Also a significant increment in TG &VLDL-c were seen in (G3) compared with (G5) (p<0.01) . There was a significant increment in previous parameters in (G3) compared with (G2) (p<0.05). No significant difference were seen in the serum levels of TC,LDL-c,HDL-c in sera of all groups.Finally no significant correlation between IR-HOMA and TAS in era of all group (p˃0.05), No ignificant correlation between IR-HOMA and S.MDA in era of different group p˃0.05 except in G4 there wa a ignificant po itive correlation between IR-HOMA and MDA (p<0.01) and also no significant correlation between TAS and MDA in different group (P˃0.05) except in (G1) a significant positive correlation was seen between TAS and MDA(p<0.05).

Purpose: The higher recurrence rate of vesicovaginal fistulae, need new modalities of repair, we evaluate the use of omental flap interposition in preventing recurrence, in comparing the repair without flap.
Materials and Methods: A prospective study on 39 patients underwent vesicovaginal fistula repair in AL-Zahra teaching hospital from May 2005 until May 2010.
16(41%) were omental flap interposition used, 10(62%) need pedicled "J" omentum flap and 6(38%) with complete omentum flap. while in 23 (59%), repair done without flap. All patients were treated from 3-6 months after fistula diagnosis.
Results: From 39 patients, 20(51%) due to obstetrical causes, 6(15%) patients following prolonged obstructed labour, 8(21%) patients following emergency cesarean section, and 6(15%) patients following emergency hysterectomy, as a consequence of rupture gravid uterus, and 19 (49%) following elective hysterectomy due to gynecological causes which includes, 3(8%) uterine fibroid,15(38%) dysfunctional menstrual bleeding and 1(3%) uterine prolapsed. The mean age of patients 37 years (20-55years).
In 16(41%) patients were omentum flap interposition used, all of them(100%) were cured, While in 23(59%) patients, repair done without flap, 4(17%) of them are failed and 19(83%) cured. Two patients from 4 patients failed were diabetic and 2 patients underwent recurrent cesarean section (CS).
Conclusion: We conclude that omentum interposition have good result in preventing recurrence of vesicovaginal fistulae, which is simple and easily done.
Keywords: vesico-vaginal fistula, omentum flap, cesarean section.

Background: ERCP is an invasive procedure which combines the use of x ray and endoscopy to provide a reliable way for diagnosis and treatment of hepatobiliary diseases. The diagnostic role of ERCP has largely been replaced by MRCP (Magnetic Resonance cholangiopancreatography). The valuable use of ERCP has, however, been associated with significant morbidity and mortality. Aims: 1) determine the safety of ERCP procedure in elderly patients. 2) compare the local complication rates with international standards using international large scale studies and British Society of Gastroenterology audit rates as standards. Patients and Methods: 1) Retrospective study on 106 elderly patients (over 80) 2)Cases were identified using local register and profoma used to collect data. 3)Completed data were submitted for collation and statistical analysis. Results: The research revealed the following rates for local complications. 1) acute pancreatitis: 5%. 2) Hemorrhage: 0%. 3) Acute cholangitis: 1%. 4) Dudenal perforation: 0%. 5) Death: 1%. Conclusions: 1) Elderly patients tolerate ERCP as good as young patients despite their advanced age and co-morbidities. 2) The local complication rates fall within the international ranges

Background: Many local procedures had been described for the treatment of rectal polyps by a lot of centers throughout the world including staplers, local fulguration, transanal endoscopic microsurgery (TEM), etc. We tried using Barron band ligation for the purpose of removing these polyps as a new application for this procedure which has been used previousely as one of the standard procedures for the treatment of hemorrhoids.
Methods: In the period between the 18th of April 2001 and the 27th of September 2008, 56 patients with rectal polyps had them removed using Barron band ligation in the outpatient clinic under simple analgesia and direct proctoscope vision and the excised polyps had been sent for histopathology study. Mean follow up time was 36 months to detect any recurrence or complications of the procedure.
Results: 48(86%) were males and 8(14%) were females. 51(91%) of the polyps had been discovered to be benign and 5(9%) malignant. 2(4%) had bleeding postoperatively, 3(5%) had urological symptoms and many had suffered a simple postoperative pain that responded to simple analgesia. No recurrence had been reported after a mean follow up time of 36 months.
Conclusion: Rubber banding ligature is:
A safe and easy procedure.
Associated with an acceptable low complication rate.
Can be performed in an outpatient clinic and needs only simple analgesia.
Has a high cure rate for rectal polyps.

Background: Polycystic ovarian syndrome (PCOS) is a common endocrinopathy characterized by oligo-ovulation or anovulation, signs of androgen excess, and multiple small ovarian cysts. PCOS is thought to be one of the leading causes of female subfertility.
Aim of the study: Evaluate the activity of finasteride - OCP combination in treatment of PCOS related infertility.
Patients and Methods: Thirty nine infertile married women at reproductive age were involved in this study; they all were complaining infertility due to PCOS. The diagnosis of PCOS was established depending on the presence of at least two out of three of Rotterdam criteria. The Patients were treated with finasteride 5 mg daily concomitantly with an oral contraceptive pill (OCP) continuously for 2 months.
Results: The present study, found that the percentage of patients responded to the treatment with finasteride-OCP combination was (35.89%). The mean number of mature follicles, endometrial thickness & pregnancy rate per patient were (1.21  0.42), (7.261.1 mm) & (21.42%) respectively, whereas miscarriage rate was (0.0 %).
Conclusion: The oral finasteride-OCP combination had a good promising effect in the treatment of PCOS related infertility.
Keywords: Finasteride, Oral contraceptive pill, Polycystic ovary syndrome, Infertility

Aim of study: detection of the accuracy; sensitivityand specificity of sonography in detection of different intra abdominal injury in patient with blunt abdominal trauma in comparism with CT SCAN
Patients and method: we examined 326 patient with blunt trauma from June 2009 till July 2011 all underwent emergency ultra sound at al – Hilla teaching hospital to evaluate whole abdomen with blunt trauma all patient where identified and their result are compare with thir CT scan in correlation with clinical outcome]
Results: 326 patient where done for them ultra sonography with CT scan examination ; where 22 true positive from the 326 those are of different intra abdominal injuries from ;haemoperitonium ; solid organ injury ; till mesenteric injury ;292 true negative from the total 326 and two are false positive and10 false negative ; sensitivity of us are of 69%;andspecifity of 99%; and diagnostic accuracy is 96%
Conclusions: Although the sensitivity andspecifityand diagnostic accuracy is not as high as CT scan still is the 1st investigation bed side examination and recommended in emergency department