Karbala Journal of Medicine

b
ackground: Mesh herniorrhaphy (open method or through laparoscopic approach) is a
common surgical procedure. Identification of the mesh is necessary when abdominal
ultrasound is performed. Scanty studies had been involved in the Ultrasonographic
appearance of mesh in the early post-operative period.
Aim: to assess the ultrasonographic appearance of polypropylene meshes used for anterior
abdominal wall hernia repair.
Patients and methods: Sixty five patients with different types of anterior abdominal wall
hernias (epigastric, umbilical, inguinal and incisional) treated with mesh herniorrhaphy, were
examined with ultrasound in the early post-operative period. Ultrasonographic appearance of
the mesh including visibility of the mesh, regularity, twinkling and posterior acoustic
shadowing were assessed.
Results: Sixty five patients were examined and most of them were males. All meshes were
visible. Most meshes were wavy and showed posterior acoustic shadowing. Twinkling was
rare.
Conclusion: Ultrasound is very useful in identification of the meshes implanted for hernia
repair within the early post-operative period and can identify all implanted meshes

b
ackground: Surgery is the treatment of choice for hepatic hydatid disease but surgical
treatment carry the risk of recurrence if we do not use a proper scolicidal agent and
may convert patient with solitary hepatic hydatid cyst to patient with many incurable
cysts. The ideal scolicidal agent should kill vital scolices, and not have local or systemic
adverse effect, and not toxic to bile duct. Yet, there is no ideal scolicidal agent involving such
effects. One of the important serious complications after instillation of scolicidal agents is
sclerosing cholangitis.
Aim: to assess the risk and severity of povidone iodine and hypertonic saline induced
sclerosing cholangitis in guinea pigs.
Materials and methods: In this study we used twenty guinea pigs which were divided into
two equal groups. In the first group 0.3 ml10% povidone iodine was injected to the biliary tree
after clamping then released after five minutes and second group, 0.3 ml 20% hypertonic saline
was used.
Four months later on the pig was euthanized by ether and three biopsies taken from the liver
and sent for histopathological examination. Afterwards, the liver, gall bladder, the common
bile duct and the duodenum were excised in one piece and immediately transferred for
cholangiography. Two X-ray films were taken for each specimen in lateral and antero-posterior
view after contrast material injection.
Results: in povidone iodine group 8 animals (80%) had sclerosing cholangitis while in
hypertonic saline group only 2 animals (20%) had sclerosing cholangitis. This difference
between the two groups was statistically significant.
Conclusions: Usage of 10% povidone iodine as a protoscolicidal agent carry high risk of
sclerosing cholangitis

b
ackground: Environmental factors are believed to explain a large proportion of
breast cancer incidence. Known risk factors for breast cancer, which are related to
women's reproductive life, and other factors, such as inheritance, chemicals and
ionizing radiation is an established environmental risk factor for breast cancer. In order to
better understand how environmental factors affect breast cancer in women the researcher
study this subject.
Objectives: 1.To determine the effect of environmental factors on breast cancer occurrence.
2. To find out the relationship between breast cancer occurrence and the environmental
factors.
Methodology: A Retrospective Study, a purposive sample of (400) women; (200) women
diagnosed with breast cancer were visited the Merjan Teaching Hospital Oncology Cancer
Center in Babylon Governorate as a study group and (200) women free of breast cancer as a
control group. An assessment tool was constructed for the purpose of the study , it was
comprised of Demographic Data, Reproductive Data, and Information of environmental life
factors consist of (11) items of 10 years previous breast cancer occurrence divided to two
periods (previous 1-5 years) and (previous 6-10 years). Physical measurements (Height and
weight) for measuring (BMI) of samples. Analysis of data was performed through the
application of descriptive and inferential statistical data analysis approach.
Results: The study demonstrates that the highest percentage (39.5%) of study sample was in
age (50-54) years in comparison with the other age groups for both of study and control
groups. There are a significant different at P<0.05 between the environmental factors and
breast cancer.
Recommendations: The study recommended about further study on large population and
activation of media and Ministry of Health role for increasing the awareness of women and
their families about the importance of reducing the risk factors which contributing on breast
cancer occurrence such as chemical products and radiation hazards

background: Haemangiomas, are rapidly growing benign vascular tumors rarely
seen in paranasal sinuses. They are of two major types, capillary and cavernous
depending on the dominant vessel size on microscopy. The sinonasal cavity is an
uncommon site of haemangiomas of the head and neck. Most nasal haemangiomas
arise from the nasal septum or vestibule and are of lobular capillary type. Only a few arise
from lateral wall of the nose or the inferior turbinate and these are usually cavernous.
Objective: To assess the sinonasal haemangioma and to increase awareness about its clinical
presentation and management.
Methods: A retrospective study was conducted in the Department of ENT at Al-Hussein
Teaching Hospital, Karbala, from December 2013 to December 2015. Ten cases of sinonasal
haemangiomas were collected. Evaluation of the patients done according to age, sex,
occupation, complaints regarding headache, nasal obstruction, epistaxis, nasal discharge,
feeling of nasal mass ,radiologic assessment and pathologic diagnosis . Endoscopic sinus
surgery was performed under general anesthesia for all patients, the masses excised
completely and sent for histopathological study.
Results: Ten patients were collected. Four patients were males and six patient females with
female to male ratio 1.5:1. The age range was 14 to 50 years with a mean age of 32 years.
Nine patients (6 females) and (3 males) presented with nasal obstruction and epistaxis. Four
patients with left sided nasal obstruction, five patients with right sided nasal obstruction, and
only one patient with absolute bilateral nasal obstruction without epistaxis.
Conclusion: Sinonasal haemangiomas are extremely rare especially cavernous type.
Sinonasal tumors with bone erosion should not always be presumed to be malignant
.Endoscopic sinus surgery with complete removal is the treatment of choice

background: Dacryocystorhinostomy (DCR) is an operation that has been used for the
past 100 years. Endoscopic endonasal DCR is less invasive than external DCR;
therefore, it has rapidly gained acceptance for the treatment of intractable nasolacrimal
duct obstruction and chronic dacryocystitis. Many ophthalmologists still believe that external
DCR is the gold standard treatment for nasolacrimal duct obstruction. However, because
incision of the facial skin is required, patients are reluctant to undergo external DCR.
Objectives: To analyze the results of Endonasal Endoscopic Dacryocystorhinostomy regarding
complications and success rate.
Methods: A prospective study was carried out on 26 patients at Department of Otolaryngology,
Al-Hussian Teaching Hospital, Karbala during the period September 2013 to November 2016.
Patients presented with epiphora and diagnosed with chronic nasolacrimal duct obstruction
were included in this study. Endonasal Endoscopic Dacryocystorhinostomy was performed
under general anaesthesia. Patients were followed up for at least 6 months after the removal of
dacryocystorhinostomy tube. Complications during and after the procedure were recorded.
Results: Out of total 26 patients 23 (88%) were females and 3 (12%) were males (F:M=7.7:1).
The age range was 6 to 60 years with a mean age of 33 years. The duration of symptoms ranged
between 8 months to 6 years. There were only 2 (8%) patients had bilateral symptoms while
the other 24 (92%) patients had unilateral symptoms. Average duration of endoscopic DCR
was 60 minutes. DCR tube was removed 6 months after operation in 24 (92%) patients and in
2 (8%) patients, it was removed after 3 months. Complications encountered during and after
surgery were, haemorrhage in 4 (15%), ecchymosis in 2 (8%), nasal adhesions in 2 (8%),
granulations at osteotomy site in 1 (4%), retrograde tube displacement in 2 (8%) patients.
Overall, 24 (92%) patients were symptom-free 6 months after the removal of the tube. Out of
the remaining 2 (8%) patients, one patient underwent revision surgery and was symptom-free
6 months after the removal of the tube whereas the other refused revision surgery. Overall
success rate of endonasal DCR was 25 (96%).
Conclusions: Endonasal Endoscopic Dacryocystorhinostomy is an effective procedure with
high success rate and minimal complications.

b
ackground: Epilepsy is the second most common chronic neurological disorder after
migraine affecting 2% of population with a high incidence of failure to achieve seizure
freedom with the usual antiepileptic drugs. Levetiracetam (LEV) is an antiepileptic
drug with less drug interactions, minimal side effects, a favorable pharmacokinetic profile and
a wide spectrum of anticonvulsant effects in animal models for different types of epileptic
seizures.
Objectives: To define the efficacy and safety of LEV in the treatment of epilepsy as add on or
monotherapy.
Introduction
Patients and methods: A random sample of 52 patients with epilepsy, evaluated in a
descriptive cross-sectional study for the efficacy and safety of LEV in epilepsy, they were
collected among epileptic patients attending the Neurology consultation Clinic in Sulaimani
city in the Iraqi Kurdistan Region from May 2012 to May 2013. All the patients were
interviewed by using questionnaire forms with comprehensive history, clinical examination,
radiological, EEG and laboratory studies done to all patients.
Results: The sample involved female patients 2 folds more than males. Mean patients age was
24.54 ± 13.9 years. Mean duration of treatment; 2.7 years. Mean LEV dosage: 1457 ± 682 mg
/ day. Seventeen patients received monotherapy and 35 patients received add on therapy. Mean
Seizure frequency was 44 attacks / month before treatment and 4 after treatment. Mean percent
of seizure reduction was 95.1% in mono therapy and 91.46% in add on therapy.
Conclusion: LEV is a safe, effective, broad spectrum antiepileptic drug that could be used as
monotherapy or add on therapy in the treatment of generalized and focal epilepsy.

bBackground: By definition, the obstructive lung diseases, abbreviated as (OLD), are chronic
inflammatory conditions of the lungs. These include two distinguished intities, asthma and
chronic obstructive pulmonary disease (COPD). In both asthma and COPD the chronic
inflammation and structural changes of the respiratory tract are organized by cytokines which
have become important targets for the development of new therapeutic strategies in these
diseases. Glutathione peroxidases (GPX) is one of the scavengers of antioxidant enzymes
against activated oxygen species which is the first discovered in mammals. The efficacy of
glutathione peroxidase enzyme is correlated with an amino-acid called selenocysteine
especially when found at a position within the catalytic site.
Aim: The goal of the current study is to Predict if there is any association between GPX
antioxidant enzyme activities as a marker of oxidative stress status. Furthermore, to test the
role of serum level of IL4 as a causative cytokine in the pathway of OLD pathogenesis.
Methods: A total of fourty Patients diagnosed by a specialist physician to have OLD were
selected as a test group. In addition, 40 age-and gender- matched apparently healthy persons
were invited to participate in the current study after obtaining their consent. Blood samples
were processed to measure serum level of IL-4 by ELISA. Similarly, the serum level of enzyme
GPX was estimated. Statistical analysis was performed to investigate the association of IL-4
and antioxidant enzyme GPX with the development of OLD.
Result: Data from the current study revealed a significant increase in serum level of the level
of IL-4 in the OLD patients in comparison with healthy persons (P <0.05). On the other hand,
the enzyme serum level of GPX revealed non-significant difference among the study
participants.
Discussion: As shown by present results, there is significantly increase in levels of IL-4 in
serum of patient group compared to control group. This finding is in agreement with a report
which indicated that IL-4 marker of allergic airway inflammation.
Conclusion: Serum levels of inflammatory cytokines IL-4 is associated with the diseases
severity of OLD and can be regarded as an important immunological player in the development
of this condition.

b
ackground: Birth asphyxia has multi system effect, which predisposes to
coagulopathy by enhancing consumption of platelets & some clotting factors as a
results of the associated sever hypoxemia, acidaemia & sepsis
Objective: To study the effects of birth asphyxia & perinatal events on the
coagulation status of newborn infants.
Patients & Methods: Across sectional study was done on 27 neonates with birth asphyxia in
AL-Zahraa teaching hospital in Najaf city from period of first of February 2012 to first of
July 2012. Blood samples were collected from the neonates within the first 24 hrs. After birth
and sent for investigations including PT, PTT, plasma fibrinogen and platelet count.
Results: The study showed statistically significant effect of birth asphyxia on platelet count
especially in severely asphyxiated neonates with Apgar score of 0 – 3 at 5 min after birth
(plat. Count < 100,000 per mm3) in comparison to neonates with Apgar score of 4 – 6 at 5min
after birth.
Introduction
Infants who have very low birth wt. (i.e. <1500 gms) had significantly lower platelet count (<
100,000 per mm3) than infants with birth wt.>1500 gms
Birth asphyxia had no significant effect on PT, PTT, or fibrinogen level. Other perinatal and
prenatal variables examined as (sex, maternal hypertension, DM, mode of delivery
gestational age) did not show any significant association with coagulation status.
Conclusion: Thrombocytopenia (plat. <100.000 per mm3) is seen in neonates with Apger
score (0-3) at 5 min. and in neonates with very low birth wt. <1500gms). No statistically
significant relation between birth asphyxia and PT, PTT and plasma fibrinogen level.

b
ackground: Several pathologies of the oral cavity have been associated with tension.
The association between stress and the occurrence of oral disease is based on clinical
observations, epidemiological research, and experiments with animals.
Aim of study: The aim of this study was to identify the effect of acute tension on
some salivary glands functions, and relationship the age with this tension
Materials and Methods: Twenty three of students from AL-karama school of girls (age 7-12
year) and thirty undergraduate pharmacy females students (age 20-24 year) were participated
in this study. They were asked to provide two samples of unstimulated whole saliva for 5
minutes, the first sample collected after a week end in the usual academic day as a control
group, the second sample was collected after
one month later in a first day of final
examinations of a scholastic year. Total protein, albumin, uric acid and calcium levels in tow
samples were assessed.
Results & Discussion: The results showed a significant stress mediated decrease in the salivary
calcium concentration (2.8813 mg/dl) in comparison with non-stressful condition (6.8020
mg/dl). and albumin concentration (1.608 g/dl were decreased by comparison with normal
value (2.818 mg/ dl), while uric acid (6.874 mg/dl in sample under stress, 4.330 mg/dl in
normal sample) and total protein concentrations (75.20 g/l for girl without stress, 107.15 g/l
under stress) were elevated respectively all these result in age range (20–24year). While in
age range (7 – 12 year) the result was as a follow:- for uric acid the value for sample under
stress was highly than in normal condition (5.118 mg/dl while to sample without tension is
3.200 mg/dl). level of albumin is (2.195 g/dl to girl under stress and 4.388 g/dl in normal
condition) that men there is a significant decrease in albumin level .also the result showed a
significant decrease change in calcium level (2.6707mg/dl while in normal sample is 5.038
mg/dl) also we showed a significant elevation level in total protein (81.567g/l) comparison
with normal sample (68.600 g/l) all these changes were statistically significant as we showed.
Our search also compared between the age group and its relationship with acute tension. So,
the level of uric acid in age (7-12 and 20 -24) are (5.118 mg/dl , 6.874 mg/dl) sequential ,while
non-significant change in level of albumin in both age group in opposite to value of calcium
and total protein we showed a highly level in age between (20- 24 year) in comparison with
(7-12 year).
Introduction
Conclusion The results suggest that acute psychological stress exerts its effect on salivary
composition and this will increase the value of saliva as dynamic biological fluid in controlling
the oral health. Also this search suggest the effect of age to the composition of saliva

b
ackground: Antibiotics (AB) are available and widely used all over the world.
However, the overuse and misuse of antibiotics generates unnecessary costs, produces
unwanted side effects, and causes the emergence of resistant bacteria that is a raising
serious problem especially in developing countries.
Objectives: To assess the use of antimicrobial drugs and rationality of its use.
Methods: An analytic cross-sectional study was carried out in Al-Hussein Teaching Hospital
in Holly Kerbala City in Iraq. A sample of 302 hospitalized patients was randomly selected
from coronary care unit, medical wards, and surgical wards, clinical data were collected using
specific questionnaire through direct interview with patients and from patient’s case sheets
during the period from 5th December 2013 to 30th June 2014. Ethical approval was taken from
Scientific Council of Family Medicine in Arab Board Committee\ Baghdad. Data were entered
and analyzed using SPSS program version 16. A p value of less than 0.05 was considered
statistically significant.
Results: Antibiotics were prescribed in 81.5% of hospitalized patient. The collective rate of
irrational use of antibiotics was 83.3%. Inappropriate antibiotic use was significantly higher in
patients who had been hospitalized in surgical branches wards (91.8%) followed by general
surgery wards (88.4%), while the lower antibiotic misuse was in coronary care unit ward
(73.9%). ABs indication in Medical wards was 100% Empirical, while 75% of ABs indication
in General surgery ward was prophylactic.
Conclusion: The rate of irrational antimicrobial use was high in hospitalized patients, and more
in surgical wards. The antibiotic selection was optional and not according to any guidelines or
recommendations. The antibiotics prescription was mainly empirical in medical wards, while
it was prophylactic in surgical wards. Further, the use of culture and sensitivity test was very
limited. These attitudes are probably leading to more risky side effects and drug resistance.
Strict guidelines and valid policies need to be adapted in each hospital to decrease the antibiotic
misuse.

b
ackground: Preterm infants exposed to prolonged excessive noise are also at
increased risk for hearing loss, abnormal brain and sensory development, and speech
and language problems.
Aim of study: to determine noise levels in the neonatal care unit.
Materials and methods: A descriptive cross sectional study was conducted at neonatal care
unit of Al-Sader Teaching Hospital in Misan Province, South East of Iraq during
October/2015. A portable sound pressure level meter (sound level meter model SL-4010) was
used to record sound level.
Results: The records of mean, maximum and minimum sound levels were high and mainly
during day time at 10:00 a.m. ranging between 65.13 to 71.68, 78 to 83 and 47 to 61 decibel
respectively which exceed the American Academy of Pediatric recommendations.
Conclusion: The noise level in the Neonatal Care Unit of Al-Sader Teaching Hospital was
obviously high and did not meet the American Academy of Pediatric recommendation. A real
effort is required to establish guidelines for noise reduction

b
ackground: medical students experience a high level of stress during their
undergraduate course. High level of stress may have a negative effect on cognitive
functioning and learning of students in the medical school.
The objectives: to assess stress, self-esteem among medical students and some factors effect
on them and the effect of stress on self -esteem.
Material and method: (185) undergraduate students of medical college Babylon university
that were selected randomly. A written questionnaire about some socio-demographic
information, assess the stress and the self -esteem. Weight and height of the participant students
was also taken.
Results: (49%) of participants have normal Self-esteem and (57%) of participants have
medium stresses and low level of high stress (14.8%) with no significant associations of stress
with participant gender , study level and residence and with body mass index with increase in
frequency of high stress in underweight students. There was significant association of Self
Esteem Scale with study level, delay in academic years and using computer and reduce level
of self-esteem with increased level of stress
Conclusion: about half of students reported normal self -esteem with medium stress and low
level of high stress during period of examination and reduce level of self-esteem with increased
level of stress.

background: The development of a strategy to promote patients' rights and
responsibilities has to be carefully prepared, in order to ensure that the intention is
translated into practical action, which commands the support of all parties involved.
Such action does not follow automatically, but takes time to become fully effective. National
situations vary in respect of legal frameworks, health care systems, economic conditions, and
social, cultural and ethical values. Patients’ rights, is recently introduced term in health
sciences literature and practice and has become an important part of modern health care
practice. Patients now are much more aware of what they expect from health care
professionals, when they enter the health care environment.
Objective: The main objective of this study was to determine the level of awareness of rights
and responsibilities among hospitalized patients' in Karbala city.
Patients and Methods: Across-sectional study was conducted in Karbala city center of
Karbala governorate, the study consists of (200) patient recumbent in public hospitals and
data were collected by direct interview with those patients by using a questionnaire form
designed by the author based on WHO legislations' this questionnaire consisting of three
parts form (some demographics characteristic, patients Rights' and patients
Responsibilities).Statistical analysis was done by using Chi-Square (χ2) test.
Results: Most patients did not know about the patients’ bill of rights, even though they are
spontaneously practicing their rights and responsibilities.
Conclusion: - Despite the enjoyment of the patients were lying in government hospitals full
rights enshrined internationally, there was a lack of patients' awareness regarding the patients'
rights and responsibilities.

bPurpose: To report a rare case of bilateral choroidal osteoma with choroidal neovascularization
(CNV) in an oriental black young man.
Design and methods: A 29 year-old Iraqi man who presented with a gradual decrease in vision
in his right eye for 3 months duration. ophthalmoscopic examination showed bilateral
juxtapapillary yellow orange slightly elevated mass about 2 disc diameter around the disc with
clear margins. Invasion of right macula from inferionasal side were observed. Optical
coherence tomography (OCT), Fluorescein angiography (FFA), ocular ultrasound, and
computed tomography (CT) confirm the diagnosis of bilateral choroidal osteoma with right eye
choroidal neovascularization (CNV)

background: The thyroid gland is an endocrine gland that is normally positioned
in the lower neck. Cardiovascular alteration that coexist with thyroid gland
diseases could trigger off the secretion of Brain natriuretic peptide from heart.
Stress environment conditions and various factors have an important thumb in
pathogenesis of thyroid gland diseases and may possibly eventuality lead to this reply.
Volume expansion and pressure overload stimulated Brain Natriuretic Peptide secretion
from the ventricular myocardium.
Aim: To evaluate the role of thyroid disorders in stimulating ventricular
myocardium's to screate Brain natriuretic peptide.
Materials and Methods: Serum Brain Natriuretic Peptide determined by enzyme-
linked immunosorbent assay (ELISA). About 36 Iraqi patients with primary
hyperthyroidism and primary hypothyroidism and Twenty two subjects who are
apparently healthy were enrolled in this study.
Results: Serum levels of BNP hormone showed a significant elevation in
hyperthyroidism as compared with control (p<0.01) and significant decrease in
hypothyroidism group compared with control group. The results revealed a significant
positive correlation between T3, T4 and BNP level in patients with hyperthyroidism
while there was no weighty relation between the corresponding thyroid hormones and
BNP level in patients with hypothyroidism.
Discussion: A raise in cardiac output, total blood volume, left ventricular end-diastolic
volume (LVEDV) and heart rate in hyperthyroid status exerts the “stress” of the cardiac
muscles and could be potential stimuli for the emission of BNP.
Conclusion: the measurement of BNP is mine important in patients with
hyperthyroidism compared with the cases of hypothyroidis.

b
ackground: Cardiogenic shock is the leading cause of death in patients hospitalized
for acute myocardial infarction. Treatment strategies using intra-aortic balloon
counter pulsation and emergency revascularization by percutaneous coronary
interventions or coronary bypass surgery have been shown to improve outcomes.
Aim: to provide an overview of patients with cardiogenic shock complicating acute
myocardial infarction admitted to Ibn Al-Bitar center for cardiac surgery in Baghdad.
Methods: This is a prospective observational study conducted at Ibn Al-Bitar center for
cardiac surgery in Baghdad. The criteria of the British cardiovascular intervention society
were used to identify patients who were admitted to the hospital within one year period with
the main focus of the study was on patients with cardiogenic shock complicating acute
myocardial infarction. Full clinical assessment was done at bedside. Twelve leads
electrocardiography and basic biochemical tests were obtained and echocardiography was
done for every patient.
Results: During a period of one year from March 2010 through March 2011 One hundred
seventeen patients with cardiogenic shock were identified. Acute myocardial infarction
accounted for shock in 78(66.7%). In this patients population there were good percentages of
history of myocardial infarction, hypertension, diabetes and smoking. Anterior ST–elevation
myocardial infarction was found in two-thirds of them. Predominant left ventricular failure
caused cardiogenic shock in 54(69.2%), while ventricular septal rupture, acute mitral
regurgitation and right ventricular failure accounted for the rest. The overall mortality rate of
cardiogenic shock was 64 (82.1%). Intra-aortic balloon pumping (IABP) was placed in 28
(35.9%) and Thrombolytic therapy was used in 19 patients (24.4%), while Both IABP and
thrombolytic therapy were used in 8 (10.3%). Coronary angiography was done in 18
(23.07%). Percutanous coronary intervention was used in 10 (12.8%), while coronary artery
bypass grafting was done in 3(3.8%) of the patients.
Conclusions: This study shows a high in-hospital mortality for patients with cardiogenic
shock complicating acute myocardial infarction and despite the proven benefit of
revascularization procedures there were only few patients had undergone these
Procedures. The utilization rates of thrombolytic therapy and intra-aortic balloon pump were
also low.

background: lung cancer is the most frequent cancer related cause of death for both
gender, currently 10 millions new lung cancer are diagnosed each year worldwide.
Objective: To determine the different clinical characteristics and other features of lung
cancer in the different age groups.
Methodology: This was descriptive retrospective study carried on 32 patients with histological
proven lung cancer under the age of 40 years from three medical centers. All patients underwent
full clinical assessment including history (particularly smoking) and full physical examination
Bronchoscope was done to all patients except those unfit pleural effusion cytology and pleural
biopsy done to all patients with pleural effusion. FNA Cytology done under ultrasound guide and
was of great help in those patient in whom the histological diagnosis was difficult to be obtained
by other methods.
Results: The age of studied group ranged between (10_40 years) with a mean of 25. From the
thirty two patients, there were 18 males patients (56%) and 14 females patients (44%), with 1.3:1
male: female ratio. History of smoking in the young age group was present in19 patients (60%),
13 were males (68.5%) and 6 patients (31%) were females, and 13 patients (40%) never smoked
.Undifferentiated carcinoma is much more common in males than females (20% and 8%
respectively). The most common histological types of lung cancer in both sex of young group was
adenocarcinoma (44% of cases) occurring 50% of females and 40% of male.
Conclusion: Cigarette smoking is an important cause of the current epidemic of lung cancer
among our young patients, so it is preventable rather than curable medical problem.
Adenocarcinoma was the most frequent histological type of lung cancer in Iraqi young patients.

b
proliferating pilar tumor (PPT) is a rare neoplasm arising from the isthmus region of
the outer root sheath of the hair follicle. It is also commonly called a proliferating
trichilemmal cyst. It was first described by Wilson-Jones as a proliferating epidermoid
cyst in 1966. PPT was then distinguished from proliferating epidermoid cysts in 1995. It occurs
most commonly on the scalp of middle age women. Most tumors arise within a preexisting
pilar cyst. Even though they usually are benign in nature, malignant transformation with local
invasion and metastasis has been described. They may be inherited in an autosomal-dominant
mode, linked to chromosome 3.
Aim of study is to report case of proliferating trichilemmal tumor