Iraqi Postgraduate Medical Journal

BACKGROUND:
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), an immune-mediated disorder
of peripheral nerves and nerve roots. Dysautonomiais has not been studied deeply and many question
not answered.
OBJECTIVE:
To estimate the prevalence of dysautonomia in chronic inflammatory demyelinating
polyradiculoneuropathy in a group of Iraqi patients .
METHODS:
A cross sectional study of 23 patients fulfilled the diagnostic criteria for definite chronic
inflammatory demyelinating polyradiculoneuropathy underwent autonomic function in cross
sectional study which has been done in Al-Imamain Al-Kadhmiyain Medical City from December
2008 to November 2010 to detect any abnormalities in sympathetic and parasympathetic autonomic
nervous systems tests.
RESULT:
This study includes 23 patients diagnosed with CIDP, 12 patients (52%) were male and 11 patients
(48%) were females. Twenty patients had autonomic dysfunction, either clinical or subclinical or
both.Eighteen of 20 patients (90%) had abnormal autonomic function tests, 16 of 20 patients (80%)
symptomatic, and 14 of 20 Patients (70%) symptomatic with abnormal autonomic function tests.
Abnormal autonomic function tests were found in 18 of 23 patients with CIDP (78%). In 8 patients
(44%), abnormal results were limited to parasympathetic function test. Five patients (28%) abnormal
results were limited to sympathetic function test. Five patients (28%) exhibited dysfunction in both
systems.
CONCLUSION:
The findings in this study suggest high frequency of clinical and subclinical dysautonomia and
parasympathetic system more likely affected than the sympathetic nervous system in patients with
chronic inflammatory demyelinating polyradiculoneuropathy.

BACKGROUND:
C-reactive protein (CRP) is an inflammation marker, which has been implicated in stroke severity,
response to stroke, or a mixture of both.
OBJECTIVE:
This study has been conducted in order to clarify early CRP essay in relation to the type of acute
stroke (ischemic and hemorrhagic), onset duration, severity, stroke disability and carotid stenosis.
METHODS:
A cross sectional randomized study included 50 patients with stroke (23 male and 27 females:
mean age 54.7 + 10.3 years). They were classified into having ischemic or hemorrhagic strokes,
deficit in less or more than 12hrs (within 24 hrs), large or small size infarction, severe or nonsevere disability and severe or non-severe carotid stenosis.
RESULTS:
There is more significant association of C-reactive protein with the ischemic (82.4%) than the
hemorrhagic types (56.3%).There is significant association of CRP positivity in relation to the late
onset duration of the deficit (> 12 hrs: 85.2%) in comparison to the early onset (≤ 12hrs: 60.9%).
C-reactive protein level showed statistically significant association with the size of infarction (CRP
is positive in 91.3% of the large size versus 63.6% of the small size). There is significant
association of CRP level in relation to carotid stenosis (68.8% in severe stenosis versus 31.2% in
non-severe ones). The short-term disability was significantly associated with CRP level (CRP is
positive in 83.8% with severe disability versus 57.8% with the non-severe one).
CONCLUSION:
High CRP level at the admission of the acute stroke patient is more associated with the ischemic
type, the late onset, the large size infarction, severe disability and severe carotid stenosis.

BACKGROUND:
The recognition of cerebellar anomalies, with the advent of neuro-imaging, has greatly improved, it
present a wide variety of clinical and radiological Imaging findings.
OBJECTIVE:
1. To describe the spectrum of cerebellar anomalies by MRI .
2. To correlate with clinical presentation.
MATERIALS AND METHODS:
Sixty six patients(22Females, 44 Males) with the diagnosis of some form of cerebellar
malformations, were included in this study, in the Central Teaching Hospital of Pediatrics in
Baghdad over 18 months from July 2103 through December 2104. They were arranged for
complete clinical and neuro-radiological evaluation. Age ranging from over 1month --- 15 years.
RESULTS:
Twenty nine patients ( 43.9 % ) had vermian hypoplasia, ranging from mild to moderate ,
cerebellar hypoplasia( 19) patients ( 28.7 % ) ,combined anomalies in 16 patients (24.4%)and 2
patients (3 %) with cystic dilatation of the posterior fossa.The bulk of cases fall in the category of
1-- 5 years age group, with the major clinical presentation being motor and speech deficits, 28 ( 80
% ) and 27 (77.1 % ) patients respectively.
CONCLUSION:
Magnetic resonance imaging is the basic modality of choice, in the setting of cerebellar
malformation, especially in the association of extreme variability of clinical presentation, and lack
of easy availability of the required cytogenetic analysis

BACKGROUND:
In the recent time, the sequence used to delineate gray matter lesions is Double Inversion
Recovery (DIR), with the use of this sequence in high magnetic field (3 Tesla machine).
OBJECTIVE:
To detect and localize gray matter lesions in patients with established multiple sclerosis using
DIR sequence in 3 Tesla MRI. Also to compare the detection rate of white matter lesions by the
use of DIR versus Fluid Attenuation Inversion Recovery (FLAIR) sequence.
PATIENTS AND METHODS:
A prospective study included 54 patients with established diagnosis of multiple sclerosis of more
than 3 years duration was conducted from April 2014 to January 2015. The study was done in
the MRI units of Al-Yarmouk Teaching Hospital and Al-Imamian Al-Kadhimian Medical City.
All patients were examined with the following MRI imaging sequences: T2WI axial, T2 FLAIR
sagittal and coronal, T1 axial and sagittal, DIR axial and coronal. T1 Sagittal and axial were
repeated after giving IV contrast and examined after 30 minutes postcontrast. Gray matter
lesions were classified according to Peterson and Bo model. Statistical analysis conducted by
using Excel 2013 version.
RESULTS:
Fifty four patients with established diagnosis of MS (43 patients with relapsing remitting MS and
11 patients with secondary progressive MS) were included. Of the 54 patients, 39 patients
(72.2%) patients have positive gray matter lesion. The 39 patients with positive gray matter
lesions are classified as follows: 26 patients (66.5%) had sub-pial lesions, 9 patients (23%) had
leucocortical lesions, 3 patients (7.5%) showed entirely cortical lesions, and finally the whole
cortex is involved in 1 patient only (2.5%). The insular cortex was the most commonly involved
region seen in 14 patients (35.8%), followed by the thalamic lesions. Among the 39 patients with
positive 9 patients (16.5%) had additional deep nuclei lesions. Total number of lesions detected
by DIR (320 lesions) was largely greater than the total number of lesions detected by FLAIR
(185 lesions).
CONCLUSION:
DIR is a sensitive sequence for detection of gray matter lesion, DIR is more sensitive than
FLAIR in detection of white matter lesions and cortical gray matter lesions are more commonly
encountered than deep nuclei lesions.

BACKGROUND:
Meningiomas and neurofibromas are the most common intraduralextramedullary tumors of of the spine
OBJECTIVE:
To study the incidence ,behavior and surgical outcome of intradural meningioma and neurofibroma .
METHODS:
This study was undertaken to analyze the 48 cases of intraduralmeningiomas and neurofibromas
between January 1995 and December 2014 a total of 48 patients underwent surgical resection of a
spinal meningioma and intraduralneurofibromas. 24 cases of meningiomaThere were 14 female and 10
male patients.24cases of neurofibroma 13 male & 11 female Age ranged from 20 to 70 years .The mean
follow-up period was 50 months (range 1–116 months) including a complete neurological examination
and postoperative MRI studies. The pre- and postoperative neurological state .
RESULTS:
Surgery was performed under standard microsurgical conditions with neurophysiological monitoring if
needed. In meningioma, 11 the lesion was located in the thoracic region, in 6 in the cervical region, in 1
at the cervico-thoracic junction, in 1 at the thoraco-lumbar junction and in 5 in the lumbar
region..Neurofibromas in24patient 13male and 11 female in10 the lesion was located in the thoracic
region, in 8 in the cervical region, and in 5 in the lumbar region,1 in the thoraco-lumbar .Surgical
resection was complete in 46 patients and subtotal in 2patients.At the last follow-up the neurological
state was improved or unchanged in 46 and worse in 2 patients in menigiomas .
CONCLUSION:
resection of spinal meningiomas and neurofibromas can be performed with good functional outcome

BACKGROUND:
Dysentery is an important cause of morbidity and mortality among children less than five years, it is
caused by viral, bacterial, or protozoan infections or parasitic infestations. About 10% of all diarrheal
episodes in children less than five years are dysenteric, but these causes about 15% of all deaths
attributed to diarrhea are dysenteric.
OBJECTIVE:
To highlight the causes and clinical manifestations of bloody diarrhea in children younger than six
years of age and to clarify the most important associated factors.
METHODS:
A prospective study was carried out on Children Welfare Teaching Hospital /Medical city/Baghdad,
on 92 children who were admitted to the hospital with bloody diarrhea, their ages ranged between
two months -6 years. The period of study is from (first of November 2013-30th of April 2014). A
thorough history were carried out, general stool examination and stool culture were done by taking
fresh stool samples collected from these children and underwent to serial investigations. Any patients
who had received antibiotics during their illness were excluded from the study.
RESULT:
Ninety two patients their age ranged from second month of life till 6 years old that admitted to the
children welfare teaching hospitals because of bloody diarrhea. The most common microorganism
isolated was E .histolytica 59(64.13%) followed by Shigella spp.11 (11.96%).
It was found that male 51(55.43%) and female 41(44.57%), most of them live in urban 39(42.40%) or
suburban 31(33.69%) area, most of them consume tap water 47(51.08%),more than half of them with
mixed feeding 42(56.75%), the most common age group affected was the first two years
74(80.43%).
Regarding the clinical presentation it was found that in amoebic dysentery the most common finding
was tenesmus 52(88.13%),followed by fever 35(59.32%), vomiting 19(32.20%),then
convulsion4(6.77%), while in Shigellosis the most common finding was fever 9(81.81%), followed
by tenesmus 8(72.72%),vomiting7(63.63%), then convulsion 4(36.36%).
CONCLUSION:
E. histolytica was the most common microorganism isolated in patients with bloody diarrhea and the
most common age group affected was the first two years of life.
Mixed feeding in the first two years was associated with higher rate of infection
Consuming of boiled water associated with least incidence of bloody diarrhea and the most common
presentation were tenesmus, fever, vomiting, and convulsion.

BACKGROUND:
Post neonatal mortality refers to deaths between 28 days and 1 year of life. It represents about one
third of infant death. Post neonatal death rates vary according to causative factors in each area of
the world.
OBJECTIVE:
To study the post neonatal mortality and its major causes in Children Welfare Teaching Hospital
(CWTH) - Medical City /Baghdad.
METHODS:
The medical records of 782 post neonatal deaths who were admitted to CWTH from 1st jan.2007 -
31st Dec. 2009 were studied, especially for the causes of death as registered in the files.
RESULTS:
The overall post neonatal death rate in the study period was 71.4 per 1000 of post neonatal
admissions. Out of 782 total post neonatal deaths, males were 465 (59.5 %) and females were
317(40.5 %). Major causes of death were; pneumonia (24.8 % ), gastro intestinal (22.8 %),
infection (18.4 % ) ,cardiovascular (10.3 % ), central nervous system ( 9.8 % ),surgical (4.9 %),
renal problems (4.9 % ), malignant causes(2.7 % ),congenital anomalies (0.7 %),inborn error of
metabolism(0.7 %) of total post neonatal deaths.
The results of this study indicate that post neonatal death rates are still high in a tertiary referral
pediatric teaching hospital in Baghdad.

BACKGROUND:
To provide an overview of pediatric tracheostomy, focusing on indications, surgical techniques
and complications. The indications for pediatric tracheostomy are changing. Today the most
common indication is assisted ventilation. Tracheostomy complications are more likely in
children than in adult and more common in children under two years particularly preterm infant.
The general indications for tracheostomy are as follows:
 Relieve upper airway obstruction.
 Prevent complications of prolonged intubation
 Reduce anatomical dead space
 Allow suction toilet of the trachea
OBJECTIVE:
To evaluate the indications and complications of tracheostomies performed in children.
PATIENTS AND METHOD:
This is prospective study of 20 patients for whom tracheostomy was done during a period of two
years (from October 2011 to October 2013).
Demographic data and details of the surgical work and the follow up notes were collected.
Descriptive, and analytic statistics were applied to the set of data using the Microsoft excel 2010
computer system.
RESULTS:
Total of twenty patients were included in the study. The age range was 2months – 12 years there
were 14 males and 6 females.
Fifty percent of the patients were 5 year old or younger.
Sixty five percent of the operations were performed as elective procedures, and 35% as
emergency.
The peak incidence of tracheostomy was at 5 years (25%).
The most common indication was the need for assisted ventilation 60%.
The most common underlying cause behind tracheostomy was the neurological impairment
whether chronic or traumatic (n=13; 65%), followed by airway trauma.
No intraoperative complications were reported, and the postoperative complication rate was
25%.
Tracheostomy tube (PORTEX blue line) obstruction was the most common encountered
complication.
Fourteen patients were decannulated (70%) with mean duration prior to decannulation 19.7±
18.95 days.
There were no tracheostomy related mortalities.
CONCLUSION:
A ssisted ventilation is the most common indication for traceostomy in pediatric age group.
Tracheostomy in children is a safe procedure with negligible intraoperative complications.

BACKGROUND:
Abdominal aortic aneurysm is a common disease of the elderly, with a complex etiology.
OBJECTIVE:
This study aimed to review the management and the outcomes of surgical treatment of the abdominal
aortic aneurysm.
PATIENTS AND METHODS:
This is a retrospective study of 20 patients who had been referred to the surgical department at Ibn alnafees hospital from 1st of January 2007 to 31th of December 2011 as cases of abdominal aortic
aneurysm. The clinical features, imaging techniques, surgical operations, morbidity, mortality and
follow up were analyzed.
RESULTS:
out of 20 patients with abdominal aortic aneurysm, there were 16 male and 4 female patients in a ratio
4:1.70% were smokers ,20% were diabetics and 65% were hypertensive .History of ischemic heart
disease was present in 55% of the patients . 20% of the patients were asymptomatic, 70% of the patients
were presented with backache followed by abdominal pain and 10% were presented with lower limb
ischemia. Pulsatile abdominal mass was felt in 75% of the cases. 75% had left ventricle dysfunction.
The transverse aortic diameter was 6-7cm in 20%, 7-8cm in 50% and more than 8 cm in 30%. All of
the patients underwent surgical intervention. The overall mortality was 20%.
CONCLUSION:
Patients who underwent urgent surgery had poor outcome in comparison with those who did the
procedure on elective basis.

BACKGROUND:
Conventionally,VentricularSeptal Defects(VSDs) are repaired with synthetic patchDacron(polyetheylene terephthalate) or Goretex(expanded polytetraflouroethylene).Recently,we
began using glutaraldehyde-treated autologous pericardial patch to repair VSDs.We review our
experience.
OBJECTIVE:
In this study,we are evaluating the result of closure of VSD by pericardial patch instead of synthetic
patch.
MATERIALS AND METHOD:
BetweenGanuary 2009 to April 2014,60 children had their VSDs repairewith glutaraldehyde-treated
autologous percardium.There were 20 males and 40 females, aged between 2 years and 12 years with
amedian age of 4 years.The diagnosis was isolated VSD in 49 patients,multiple VSD in 3:Tetralogy
of Fallot(TOF) in 8 patients The chest was opened by median sternotomyincision.After establishing
cardiopulmonary bypass,a strip of pericardium was harvasted from patient and fixed in 0.6%
glutaraldehyde for about 25 minutes.It was then washed out with 0.9% saline solution.The defect was
repaired with 4/0 suture using a continous suture technique.
RESULTS:
There was no hospital mortality. Postoperative echocardiogram reveald trivial leaking in 10
patients.Follow up was for 3 to 6 months(mean 2 months). No patient required reoperation for
residual VSD.
CONCLUSION:
Glutaraldehyd-treated autologous pericardium is an exellent material for surgical patch closure of
VSD.It is easily available and does not require sterilization.

BACKGROUND:
Varicose Veins is a common problem in our population and there are many factors which
aggravate its progress.
OBJECTIVE:
In this study the author concern on analysis of risk factors which aggravate varicosities and
management of these cases either surgical or conservative.
PATIENTS AND METHODS:
A prospective study is carried on 85 patients with varicose veins from September 2008 to
September 2014 at Al-yarmook Teaching Hospital and private sector. History, clinical
examination and Color Duplex Imaging were done for all patients and then they were divided into
two groups according to the causes of development of varicosity and method of management,
group-A include 55 patients (65 Limbs) who were managed surgically while group-B include 30
patients who were managed by conservative methods.
RESULTS:
After a mean follow up period of 30 months (rang from12-42 months). Regarding group-A
patients, 46 patients (55 limbs=84.6%) got good results, while six patients (6 limbs=9.2%)
developed variable degree of post operative foot and leg edema, in three patients (Four
limbs=6.2%) recurrence developed after three years postoperatively. Regarding group-B patients
they expressed improvement in their symptoms by conservative measures and life style
modification that help to stop the progress of varicosity.
CONCLUSION:
Varicose Veins is a common condition with many causes and aggravating factors, surgery is
excellent method to manage extensive varicosities while conservative method is suitable in certain
inoperable conditions.

BACK GROUND :
(laparatomy wound dehiscence) is a serious postoperative complication which is associated with
high morbidity and mortality rates.
OBJECTIVE:
To evaluate abdominal wounds dehiscence in term of risk factors and to assess the role of
prophylactic retention suture in prevention of wound dehiscence.
PATIENTS AND METHOD:
Prospective study done in the General Surgical unit of Al–Imamain Alkadhmain medical city on
167 patients with 20 patients underwent prophylactic retention suture, from the 1stof July 2013 to
the 1st of July 2015.and to know the effect of different factors on incidence of wound dehiscence.
RESULTS:
The number of wound dehiscence cases was 19 patients out of whole total 167 patients which
represent 11.38%. Wound infection was present in 63 patients out of 167 patients (37.2%) and 19
patients out of 63 patients (30.2%) developed wound dehiscence. The other risk factor was chest
complication which was present in 76 patients out of 167 patients (45.5%). and 17/76 patients
(22.4%) developed wound dehiscence. Smoking was present in 92/167 patients, anemia was
present in 80/167 patients and 13/80 patients (16.3%) developed wound dehiscence. Age > 50
years was present in 53/167 patients and 10 /53 patients (18.9%) developed wound dehiscence.
steroid usage found in 17/167 patients and 5/17 of them patients (29.4%) developed wound
dehiscence, and jaundice was present in 8/167 patients and two/8 patients (25%) developed wound
dehiscence. Prophylactic retention sutures were done for 20 patients all of them were male with
generalized peritonitis and emergency cases. 19 patients were anemic. 18 patients were smokers
and 15 patients were above 50 years of age; from these 20 patients only one patient who had all
listed risk factor developed wound dehiscence after prophylactic retention suture wound inspected
from 2ndpost-operative day on word
CONCLUSION:
Post-operative wound dehiscence rate in the surgical unit of Al–Amamain Alkadhmain medical
city is 11.38% and that wound infection, emergency operations and compromised immunity, are
factors which increase the rate of wound dehiscence; and prophylactic retention sutures is a
valuable maneuver to reduce it.

BACKGROUND:
Anterior cruciate ligament reconstruction (ACLR) is one of the most commonly performed
orthopedic procedures. Technical factors especially correct tunnel placement play major role in its
success. However its failure rate is still high (10%), and impingement of the graft on the posterior
cruciate ligament (PCL) and the medial wall of the lateral femoral condyle is an important cause of
failure. Wallplasty is a technique used to prevent graft impingement, but there is no consensus on
its routine use.
OBJECTIVE:
Is to compare between the postoperative knee functional outcome and stability of arthroscopic
ACLR performed with wallplasty versus those performed without wallplasty.
PATIENTS AND METHODS:
A prospective experimental non randomized study was performed on 32 patients (30 males and 2
females) who necessitated arthroscopic ACLR. The patients were divided into 2 groups, in group A
(made of 16 patients) the reconstructions were done without wallplasty and in group B (made of 16
patients) were done with wallplasty. Three months postoperatively the two groups were compared
in regard to Lasholm score changes (preoperative and postoperative), Lachman test, and Pivot shift
test results.
RESULTS:
There was better improvement in Lasholm score in group B than in group A, and the difference
was statistically significant (p value =0.036). Knee stability tests were better in group B than in
group A, but the differences were statistically not significant.
CONCLUSION:
Wallplasty has statistically better functional outcome than non wallplasty in ACLR and it is
recommended to be done routinely in all cases of ACLR.

BACKGROUND:
Computed tomography (CT) is mandatory and a medicolegal requirement to evaluate rhinosinusitis and
provides a road map regarding anatomical variants and endoscopic treatment of rhinosinusitis.
OBJECTIVE:
To identify coexistence between anatomical variants of nasal constituents and rhinosinusitis by using
multi-sliced CT and to ascertain the value of CT as a road map prior to functioning endoscopic sinus
surgery.
PATIENTS AND METHODS:
This is a cross sectional study was done on 87 patients referred for CT scan of the paranasal sinuses.
The patients were clinically suspected to have sinonasal diseases. The sample of this study was consist
of 52 males and 35 females. The age of patients ranged from 12 - 60 years. All patients were examined
by using 64 multi-slice CT scan of paranasal sinus including axial sections and coronal reformat.
RESULTS:
76 patients were had diseased sinuses, we discovered 5 abnormalities; mucosal thickening,
opacification, air fluid level, mucosal polyp and cyst. The most commonly involved sinus was the
maxillary (62 patients) followed by anterior ethmoid, and the commonest abnormality was mucosal
thickening. Types of variations include; nasal septal deviation(52.4%), concha bullosa(49%), enlarged
ethmoidal bullae (15.9%), large Aggar nasi (15.9%), Haller cells(19.1%), bent uncinate
process(11.4%), Onodi cells (11.4%), paradoxical middle turbinate(9.1%), maxillary sinus hypoplasia
(7.9%), pneumatized crista galli (6.8%), and both pneumatized nasal septum and asymmetrical ethmoid
roof were of (3.4%). The total number of patients having anatomical variants but not associated with
sinonasal mucosal abnormalities were (17.1%), while (82.9%) of patients were associated with
sinonasal abnormalities.
CONCLUSION:
The study reveals correlation between certain anatomical variations and specific sinonasal mucosal
abnormalities that may interfere with the drainage of the sinus secretions and subsequent secondary
infection. Another group of variants were discovered that may lead to intra-operative complications if
surgery indicated.

BACKGROUND:
Patients at Intensive care unit (I.C.U) admitted from different hospital departments (Medical,
surgical and obstetrics), with different presentations to the I.C.U., some of these cases need
sophisticated management and some of them need just monitoring and supportive therapy.
OBJECTIVE:
To evaluate the cases in the I.C.U regarding the gender, age and smoking status, and to assess their
clinical status and to predict their prognosis and outcome.
PATIENTS AND METHODS:
A cross-sectional study of 50 case from I.C.U of Baghdad Teaching Hospital. The period of
patients' admission from first of January 2013 to 31 of December 2013. Patients 18 year of age and
above (adults) were included in the study.
RESULTS:
From 50 case involved in the study, there was 29 (58%) male and 21 (42%) female, among 29
males there was 14 case (48.3%) survived and 15 case (51.7%) Died, while female 11 case (52.4%)
survived and 10 cases (47.6%) died. The survival rate lower among smokers; male (25%), while
non-smoker male was 64.7%, however the survival rate was higher (100%) for those with
hypoxemia without respiratory failure, but patients (especially male cases) who received
mechanical ventilation showed very low survival rate (37.5%) compared to those on oxygen
therapy with survival rate (72.2%).
CONCLUSION:
Smoker patients showed lower survival than non- smokers. Patients who received mechanical
ventilation showed very low survival rate in comparison with those on oxygen mask therapy.

BACKGROUND:
Diffusion-weighted imaging (DWI) is increasingly used for the detection, characterization and
diagnosis of various focal liver lesions (7-10).
OBJECTIVE:
to investigate the utility of (DWI) in evaluating solid focal liver lesions, and to measure the ADC values
of these lesions trying to differentiate benign from malignant lesions.
PATIENTS AND METHODS:
A prospective study was conducted at MRI units of Al-Imamain Al-Kadhimain medical city and
Baghdad teaching hospital between June 2014 to January 2015. Study included of 51 patients with 87
solid focal liver lesions more than 10mm in diameter. They underwent DWI using 1.5 tesla MR units
.Mean apparent diffusion coefficient (ADC) values were measured and were correlated with histopathological results as well as follow-up imaging results.
RESULTS:
Of the 87 lesions, 50 (57.5%) were malignant and 37 (42.5%) were benign. The highest ADC value was
for haemangioma with significant difference from other benign and malignant solid focal liver lesions.
Mean ADC values for FNH and HA were close to each other with insignificant P value (0.903), but
they were of significantly higher values than those of metastases and HCC. Mean ADC values for HCC
and metastases were low and close to each other with insignificant P value (0.629). The mean ADC
value of benign lesions was higher than that of malignant lesions with significant P value (0.0001). The
mean size was 33.46±23.67mm for benign lesions and 40.04±41.81mm for malignant lesions, and this
difference was statistically insignificant (P value 0.392).The mean age for malignant lesions
(55.30±7.47 year) was higher than that of benign lesions (43.14±13.70year) and this difference was
statistically significant (P value 0.0002).
CONCLUSION:
DWI is a good imaging modality for diagnosis and characterization of solid focal hepatic lesions,
particularly in patients with renal impairment. In general ADC value of benign hepatic lesions was
higher than the ADC value of malignant lesions.

BACKGROUND:
One of the important causes of obstructive jaundice is malignant tumours.
OBJECTIVE:
The current study was undertaken to describe the epidemiology of malignant extra-hepatic biliary
tract obstruction in Sulaimaniyah, Kurdistan Region, Iraq.
Patients & Methods: The study was undertaken at Kurdistan centre for gastroenterology &
hepatology in Sulaimaniyah city. Patients attending the centre during the period from 1st January
2008 to 1st January 2013 and diagnosed as having a malignancy using endoscopic retrograde
cholangiopancreatography were included in the study. A total of 259 patients were found to have
such a malignancy and therefore included.
RESULTS:
The mean age of patients was 63.5 years, the male to female ratio was 1:3 and the most common
cause of malignant extra-hepatic biliary tract obstruction was cholangiocarcinoma 47.5%, followed
by ampullary and peiampullary carcinoma 26.6%. In males, 37.7% of cancers were
cholangiocarcinoma, 30.8% ampullary and periampullary carcinoma, & 26% pancreatic
carcinoma, versus 60.2%, 21.2%, & 15% in females respectively (P= 004). Most cancers occurred
between 50-79 years of age.
CONCLUSION:
The causes of malignant extra-hepatic biliary obstruction in order of frequency were
cholangiocarcinoma, ampullary and periampullary carcinoma, pancreatic carcinoma & carcinoma
of the gallbladder.

BACKGROUND:
Breast cancer is the most common cancer among the Iraqi population. Alteration in the expression of
Fas and Fas ligand (FasL) compared to normal tissues are reported in the literature.
OBJECTIVE:
To investigate whether measuring this tumour marker in serum of breast cancer patients before and
after treatment might also be useful markers in the diagnosis, screening and monitoring the malignant
tumour progression and response to therapy.
METHODS:
Serum samples were obtained from (28) apparently healthy women (Control Group) with a mean age
of 40.9 ± 7.6 years and (60) female patients complaining from primary breast cancer (Patients Group)
with a mean age of 48.3 ± 8.9 years. They were divided according to their clinical end point into:
Pre-Surgical Group, Post-Surgical Group and post- chemotherapy Group. Serum sFas level was
measured using ELISA kits.
RESULTS:
The mean serum levels of sFas were significantly elevated (P<0.05) in breast cancer patients than
controls. There was no significant influence of the studied personal and pathological characteristics
upon biomarkers levels in any of the breast cancer subgroups (P > 0.05). sFas level was found an
effective test (P < 0.05) in both pre- surgery and post- chemotherapy groups (accuracy is 87% and 90%
respectively). At readings ≥ 300 pg/ml in both groups, sensitivity approached 85%. Fas was not found
an effective test in the post surgery group (P > 0.05).
CONCLUSION:
It could be concluded that sFas is useful for monitoring the response of breast cancer patients to
surgery and chemotherapy if the effect of systemic inflammatory reactions is excluded.

OBJECTIVE:
The study included knowledge The chemical components of the Soursop juice and determine
whether Soursop prevents ischemia-reperfusion induced brain injuries in rats.
METHODS:
The chemical components of the prepared fruit extract were detectedits components of
glycosides, proteins....etc and we were Determination of trace element and the estimation of the
biochemical parameters: Blood samples were harvested from the rats,. Serum IL-10,Adiponectin
and oxidative stress levels of Malondialdehyde ( MDA) and Glutathione ( GSH )were
estimated.
RESULTS:
The results showed that the extract contain : glycosides, proteins, saponins, tannins, various
phenolic compounds alkaloids , flavonoids, steroids and vitamine C . The results also showed
that there were high concentrations of B, Fe , Zn respectively and low concentrations of Mn, Cu,
pb,Cd respectively ,very low concentrations Ni ,Co , Se . The levels of oxidative enzymes and
Inflammatory cytokines in group 3 were significantly lower than those in the group 2.Our results
suggest that soursop treatment protects the rat brain against ischemia-reperfusion induced brain
injuries.
CONCLUSION:
The present study confirm that the fruit extracts of Soursop (Annona Muricata L.) posses in vivo
anti-inflammatory and antioxidant activity because of its content (glycosides , tannins ,
saponins ,proteins ,various phenolic compounds ,alkaloids , flavonoids, steroids and vitamine C
)

Percutaneous nephrostomy tube placement is
commonly performed to relieve urinary
obstruction. The percutaneous nephrostomy tract
is also used for the treatment of pathologic
processes,asfor stone removal.Although
percutaneous nephrostomy tube placement is a
widely accepted and a relatively safe procedure,
and it is currently the most commonly performed
uro-radiologic intervention, the clinicians should
be aware of this procedure and its potential
complication1. Potentially serious complications
may occur, including severe bleeding,septicemia
and injury to adjacent organs as bowel
perforation, splenic injury, pleural injury, liver
injury.Major complications rate of up to 7% have
been reported2.