Karbala Journal of Medicine

bPrediction of a difficult laparoscopic cholecystectomy (LC) can
help the patient as well as the surgeon to be better prepared for the intra
operative risk and the risk of conversion to open cholecystectomy. The
difficult gallbladder is the most common 'difficult' laparoscopic surgery being
performed by general surgeons all over the world and the potential one that places the
patient at significant risk. We present our experience of 300 cases since September
2007 to December 2009 in a single center with respect to conversion to open
cholecystectomy.
AIM: evaluation of difficult laparoscopic cholecystectomy and conversion rate in
different 300 cases of cholelithiasis.
Methods: Patients who underwent laparoscopic cholecystectomy (LC) from
September 2007 to December 2009 were analyzed. The cases were analyzed in
relation to conversion rate to open surgery; factors affecting pulmonary disease were
not included in the study.
Results: Out of 300 cases, 52 patients (17.33%) were identified as difficult cases.
Laparoscopic cholecystectomy was successfully completed in 295 patients with a
completion rate of 98.33%. Laparoscopic procedure had to be converted to the open
procedure in 5 patients with a conversion rate of 1.66% of the total LCs performed
and 9.6% of the difficult cases. Conversion had been done due to several reasons.
Conclusion: It can be reliably concluded that LC is the preferred method even in the
difficult cases. Our study emphasizes that although the rate of conversion to open
surgery and complication rate are low in experienced hands the surgeon should keep a
low threshold for conversion to open surgery and it should be taken as a step in the
interest of the patient rather than be looked upon as an insult to the surgeon

bMicrobial colonization and inflammation in the maternal genital
tract has emerged as one of the major risk factors associated with spontaneous
preterm birth.
Objectives: this study aimed to demonstrate the role of tumor necrosis alpha(TNF
α)in the induction of preterm labor.
Materials and methods: This study was conducted in Babylon Teaching Hospital of
Gynecology and Pediatrics from November 2007 to May 2008. A total of 60
pregnant women with preterm labor admitted to Labor Room and 20 control women
(10 of them were pregnant at term with bacterial infection, 5 were pregnant at term
without bacterial infection, and 5 were normal females not pregnants and not infected)
were included in this study. The ages of patients and controls ranged from (17-40)
years. Blood samples were collected from both patients and controls to estimate
tumor necrosis factor alpha (TNF-α by EASIA (Enzyme Amplified Sensitivity
Immunoassay) method.
Results: The results show there is significantly higher (p<0.05) in the level of TNF- α
in patients with preterm labor compared to all control groups.
Conclusion: The results clearly indicate the possible role of TNF-α in the induction
of preterm labor.

bC-reactive protein is a sensitive major acute phase reactant in
humans, whose synthesis in the liver is regulated by different cytokines . C
reactive protein is a common marker of inflammation plays a key role in the
progression of human cancer.
Objective: To detect the level of C - reactive protein in sera of patients with leukemia
and lymphoma (infected and uninfected with fungus).
Methods: Ninety six patients and hundred and fourteen control patients attended
Medical city in Baghdad over period from Oct. 2005 to Dec.2005 were included in the
study. Patients were divided into 2 groups according to the infected or uninfected with
fungi, also 20 healthy volunteers were included in this study.
Results: The level of C - reactive protein in sera of patients was significant higher
than the healthy control group (248.6+70.5) and (3.72+1.61) respectively with
(p~0.05). Also the level of C - reactive protein in sera of patients was significant
higher than the patients control group (54.3+28.14) with (p~0.05).
Conclusions: There was a significant increase in mean serum level of C - reactive
protein in patients with fungal infections.

bAntipsychotic drugs are invaluable tools in treating a large
variety of patients with schizophrenia, mood disorders with psychotic features,
senile and other organic psychoses, psychoses associated with Parkinson's
disease. Extrapyramidally mediated movement disorders represent the major set of
adverse effects associated with the use of antipsychotic medications.
Objective: Is to assess the size of the problem of extra pyramidal effects among
chronic patients taking antipsychotic medications.
Method: 100 chronic psychiatric patients attending outpatient department in Diwania
Teaching Hospital to receive their medications were assessed for extra pyramidal side
effect of antipsychotic drugs, using the Extrapyramidal Symptom Rating Scale
(ESRS). The study was conducted between the 8th of January2009 and the 8th of May
2009.
Results: the study revealed that 38% of patients on antipsychotic medication have
extra pyramidal effects. The majority of those patients (80%) were taking
anticholinergic drugs.
Conclusion: the study concludes that extra pyramidal effects are common among
chronic patients on antipsychotic medications

bAnti- Tumor necrosis factor -α (anti-TNF) therapies have shown
to slow and even halt structural joint damage in Rheumatoid Arthritis (RA).
However, therapeutic inhibition of TNF-α has approved to lead to an increase
in infections and lymphoma, hence it is mandatory to identify which patients with
rheumatoid arthritis may benefit from anti-TNF therapies.
Aim of the study: in this study we attempt to find out if any link could be drawn
between serum levels of TNF-α and some disease processes and manifestations in
RA. Such presumed link may help providing bases for patients’ selection to anti-TNF
therapies.
Methods and Material: thirty two RA patients were enrolled in this study. The
patients were diagnosed based on the American College of Rhuematology (ACR)
criteria and non of them had received anti-TNF therapy. Blood sample was taken from
each patient at time of attending; sera were separated immediately and kept frozen at –20oC until used. Disease Activity Score (DAS) was calculated using DAS28-3
formula. Radiographs were read by expert radiologists. TNF-α was measured using
solid phase Enzyme Amplified Immunoassay (EASIA), while Sandwich Enzyme
linked Immunosorbent Assay (ELISA) was used for the separate quantitative
detection of RF of the IgG, IgM and IgA classes in serum.
Results: Among the 32 Rheumatoid Arthritis (RA) patients who were enrolled in this
study, there were statistically significant positive correlations between the serum
TNF-α levels with radiological joint damage and with serum Rheumatoid Factor (RF
Latex), (p=0.015, and p=0.011 respectively). However, no correlation could be found
between serum TNF-α level with any of other disease processes and outcomes.
Conclusions: These results may further support the importance of serum TNF-α level
of erosive RA and may reflect a causal relationship between TNF- α and joint
damage. In addition, radiological changes and Latex-RF may be promising inclusion
criteria in patients’ selection for anti-TNF therapies. However, a further detailed study
using a larger sample of patients is recommended to support our results

bCardiovascular diseases are more common among type 2 diabetic
patients than healthy subjects without a family history of diabetes. Serum
interleukin-6 (IL-6) and homocysteine (Hcy) levels are markers of endothelial
dysfunction and cardiovascular disease.
Aim: this study demonstrated to evaluate levels of IL-6, Hcy and their association
with cardiovascular risk in type 2 diabetic patients with renal failure complication.
Material & Methods: The circulating IL-6 and Hcy levels were measured in 45 type
2 diabetic patients and 25 control subjects without a known family history of diabetes.
The BIOSOURCE IL-6 ELISA kit used to measure IL- 6, high performance liquid
chromatography HPLC technique used to measure serum Homocystein, and
enzymatic methods are used for blood suger, urea, creatinine, and lipid profile
measurements.
Results: A significant differences were found in serum levels of IL6 and Hcy
between the two groups diabetic and healthy control (p>0.05). IL6 levels correlated
significantly with Hcy (p=0.02), hemoglobin A1C (p=0.03), and serum Hcy correlated
significantly with HbA1C (p=0.03) levels in patients with type 2diabetes mellitus.
Conclusion: These results suggest that serum IL-6 and Hcy levels do not directly
contribute to the development of endothelial dysfunction and cardiovascular risk
factors in type 2 diabetic patients with renal failure complication

bBcl2 is known to belong to a family of apoptosis regulatory gene
products that may be death antagonist eg (bcl- 2, bcl-xl , mcl –l) or death
agonist ex (bax , bak , bcl -xs , bad) , The bcl- 2 oncoprotein inhibits apoptosis
and is expressed by many tumors including carcinoma such as breast ,cervix and head
and neck .
Aims to identify bcl-2 oncogene product expression of oral carcinoma and its
correlation to clinical features (exophytic , endophytic and mixed type) of oral
carcinoma
Patients and methods Twenty four patients were gathered , 20 patients had
squamous cell carcinoma and four patients with adenoid cystic carcinoma . Paraffin
blocks were obtained of the study group , specimens of follicular lymphoma paraffin
blocks were obtained from pathology department at teaching laboratory of medical
city . Normal oral mucosa were obtained from healthy patients who had undergone
routine oral surgery following informed consent of the patients .
Immunohistochemical procedure of Bcl2 protein were applied .
Results our study showed that 11 cases of the exophytic type of oral carcinoma
represented a positive bcl2 expression , 4 cases of the endophytic (ulcerative type)
showed a positive immunoreactivity with bcl2 antibodies and 3 cases of mixed type
(exophytic type and endophytic) showed a positive bcl2 expression . Statistical
analysis showed non significant relationship between clinical features (exophytic ,
endophytic , Mixed type) and bcl2 expression in oral carcinoma .
Conclusion :- bcl-2 expression in normal oral mucosa and oral carcinoma ,bcl-2
immunoreactivity was more correlated to mixed type , exophytic and rarely to
endophytic oral carcinoma but all didn't reach a statistical significance

bUrinary tract infection is a common source of bacterial infection
in children under five years old; urinalysis is one of the important and useful
urological tests for diagnosis of infection, microscopic examination of urine
and the dipstick urinalyses (leukocytes esterase test, nitrite test) are common tests
used for detecting bacteriurea and pyuria.
Objective: Comparison of the rapid tests: dipstick (leukocytes esterase test, nitrite
test), microscopic examination, and urine culture in detecting urinary tract infection in
children under five years old.
Method: The study conducted on 246 patients less than 5 years old admitted with
clinical suspicion of urinary tract infection in Kerbala pediatric teaching hospital in
the period from July to December 2008. All urine samples were collected then
submitted for routine urinalysis and bacterial culture, dipstick and microscopy were
done.
Results: Urinary tract infection was identified in117 patients, The sensitivity of
leukocytes esterase test was 83.7% higher than nitrite test 39.3%while specificity
was70% which is lower than nitrite test 87.6%, the positive predictive value and
negative predictive value for nitrite test were 74%, 61% respectively while for
leukocytes esterase test record 76.6%, 82% respectively.
The positive predictive value and negative predictive value for pyuria( 96.2%, 99.1%)
were higher than that recorded in both nitrite test and leukocytes esterase.
Conclusion: 1-The dipstick tests (nitrite and leukocyte esterase) have high positive
predictive value for presence of urinary tract infection.
2- The high negative predictive value of these tests doesn't exclude urinary tract
infection.
3-Acombination of microscopic examination and dipstick tests improve the sensitivity
of detecting urinary tract infections.

bthe study was carried out in an attempt to find out the effects of 0.05 ml of
autologous ofplatelet rich plasma on traumatic skin injury.
Materials & methods: sixteen male rabbits were used & divided into two group
according to killing after trauma in to group A after 1 day & B. after 4 days each
group subdivided in to control & experimental. The skin wound induced traumatically
by blade 1cm length & 2mm depth in the skin of rabbit's back, the experimental
wound filled with 0.05ml of autologous PRP, while the control wound left for normal
healing. The wound was dressed for one day.
Result: platelet rich plasma (PRP) showed marked angiogenesis, granulation tissue
formation, histological examination of biopsies revealed difference in the rate of
healing process between the control & experimental groups platelet rich plasma (PRP)
showed significant enhancement of healing.
Conclusion: platelet rich plasma (PRP) accelerate the soft tissue healing

bProstaglandins have mainly been used for postpartum hemorrhage
(pph) when other measures fail,misoprostol, a new and inexpensive prostaglandin E1
analougue,has been suggested as an alternative for routine management of he third
stage of labour.
Aim o the study: To determine the efficacy of intraumbilical oxytocin administration
compared with intraumbilical misoprostol administration for prevention of postpartum
hemorrhage.
Materials and methods: Prospective study done at Babylon Hospital for Maternity
and Pediatrics from February 2009 to September 2009.
study involved 75 women in their 3rd. stage of labor subdivided into 3 groups 25 for
each received either 30 i.u oxytocin in 30 ml saline or 800 mcg of misoprostol
dissolved in 30 ml of saline 3rd group was control received only 30 ml of saline
injected into the placental bed via umbilical vein using pipingas technique .
The primary outcome measured was duration of 3rd stage of labor , amount of blood
loss and need for manual removal of placenta. P-value of <0.01 considered
statistically significant.
Results: All groups are comparable in their demographic criteria. Intraumbilical
injection of misoprostol associated with shorter duration of 3rd stage of labor (2.5 ±
0.2 min) compared with oxytocin group (3.5 ± 1.1 min) and control group (5.56 ± 2.2
min) p value <0.0001. Blood loss was comparable in both misoprostol and oxytocin
group (31.6± 15 ml and 33.2±18.7 ml respectively, p-value >0.05) which was
significantly lower than control group (147.1 ± 99 ml) p value <0.0001. No reported
cases of retained placenta in both oxytocin and misoprostol groups compared with 2
cases (8%) in control group. Further uterotonic drugs required in 20% of control
group. No significant side effects reported in all study groups.
Conclusion:
1- Intaumbilical injection of 800 mcg misoprostol dissolved in 30 ml of saline using
pipingas technique was more effective than intraumbilical oxytocin in shortening the
duration of 3rd stage of labor and both reduce the incidence of postpartum
hemorrhage.
2- the intraumbilical injection of uterotonics is non- invasive ,effective and clinically
safe method for management of 3rd stage of labor and prevention of postpartum
hemorrhage.

bBackground: thinking of posterior capsule after cataract surgery is a common
problem affecting vision, Nd:YAG poster capslotomy is the main treatment.
Objectives: to determent the factors affecting the required power of Nd: YAG
capsulotomy to open the opacified of posterior capsule.
Methods: In this study 67 patients were exposure of Nd:YAG laser from (Nidek yc
1600 model) laser device, which start with power of 1mj. The duration of this study
last for 10 months.
Results: The results showed inverse proportion between the power used and the age
of the patients, this results were similar in patients with hypertension and diabetes
mellitus. The dose of Nd:YAG laser has a wide variety relative to the duration after
cataract surgery.
Conclusions: the most effective factor in the power of Nd:YAG capsulotomy is the
age increase relasionship