IRAQI JOURNAL OF MEDICAL SCIENCES

Background: Doppler applications in pregnancy are expanding exponentially. Flow velocity waveforms provide important information from 12 weeks to term, from maternal vessels, placental circulation and fetal systemic vessels. An important application is the quantitative calculation of umbilical blood flow volume.
Objective: to assess the relation between the umbilical blood flow at one hand & fetal body weight & placenta weight on the other hand in the last trimester in both term & preterm labor groups
Study design: A prospective study
Setting: department of Gynecology & Obstetrics & Department of Radiology at Al-Kadhimiya Teaching Hospital
Patients & methods: This study included 50 pregnant women at first stage of labor. The patients were classified into two groups; group A: Infants born at < 37 weeks of gestation and group B: those infants born at 37 weeks of gestation .The diameter of the umbilical vein was determined by ultrasound & spectral Doppler was used to assess velocity of blood in the umbilical vein & the umbilical blood flow (UBF) per unit fetal body weight & placental weight estimated in both groups. Results : A statistically significant difference was found in the diameter of the umbilical vein (7.84 mm vs. 8.62 mm , p=0.0001) , the volume of umbilical blood flow (410.22 mL/min vs. 523.20 mL/min, p=0.0001), UBF/Fetal weight (230.68 mL/min/kg vs. 166.79 mL/min/kg , p=0.0001 ) & UBF/Placental weight(102.65 mL/min/100gm vs. 87.23 mL/min/100gm , p=0.01) of group A & group B respectively while the mean velocity of blood flow in the umbilical vein showed no statistically significant difference in both groups (14.11 cm/s vs. 14.93 cm/s , P=0.8).
Conclusion: The increase in umbilical blood flow is exceeded by the fetal growth and to a lesser degree by placenta growth. A significant reduction in the umbilical blood flow per unit fetal weight & placental weight take place with increasing gestational age.

Keywords: umbilical venous blood flow, fetal body weight, placental weight

Background: Human Respiratory syncytial virus (HRSV) is one of the major causes of bronchiolitis and pneumonia in infants.
Objective: detection of Anti HRSV antibodies in infants and children by using indirect ELISA, and detection of HRSV antigen by using Respi- RSV test.
Materials and Methods: Hundred and eighty four serum samples (104 with respiratory tract infection, 54 without Respiratory tract infection, and 26 with cancer) also 100 nasal and throat swabs were collected from infants and children from Central Pediatric Hospital in Baghdad in year (2005-2006). Indirect ELISA test and rapid test used for detection Human RSV antibodies and Human RSV antigen respectively
Results: Detection of anti HRSV antibodies using ELISA in children without respiratory tract infection was 26% with mean titer 494, but the antibodies was higher in patients with cancer which were 96% with mean titer 580, however anti HRSV was detected in79% in infants with respiratory tract infection (bronchiolitis and pneumonia), their mean titer (1411) was, higher than that of the previous two groups.
Human RSV viral antigen was detected by RSV-Respi kit in 45% of nasal and throat secretion collected from children with respiratory tract infection, detection of HRSV antigen samples was compatible with the detection of antiHRSV antibodies in 50%.
Conclusion: The highest percentage and titers of antiHRSV antibodies were detected in infants with respiratory tract infection than in others suffering from different cancers or without respiratory tract infection.
Human RSV antigens were detected in nasal/throat swabs in infants with bronchiolitis and pneumonia.

Keywords: Respiratory syncytial virus, bronchiolitis, Respi-RSV.

Background: Human prolactin can be determined in human serum or plasma quantitatively by many techniques such as ELISA, RIA, and ELFA (miniVIDAS).
Objectives: To estimate the strength of association of total serum prolactin and free serum prolactin values measured by two different methods [RIA and VIDAS]. And to predict the prolactin value measured by RIA corresponding to a given value by VIDAS.
Methods: Two technical methods VIDAS and RIA were used in determination of prolactin level in sera of twenty five women with uterine fibroid conducted at two laboratories admitted at Al-Kadhimiya Teaching Hospital during the period January 2008 to April 2009. Total and free serum prolactin was measured by both VIDAS and RIA using their assay kits. Statistical methods of correlation and regression were used to compare between the two methods.
Results: The study revealed a highly significant positive correlations between VIDAS and RIA total and free serum prolactin, r=0.999, R2 = 0.998, P<0.001, r=0.998, R2 = 0.997, P< 0.001 respectively. High linear regression equations were found between VIDAS and RIA total and free serum prolactin, y= 0.358x+ 0.57, R2 = 0.998 and y= 0.355x+0.49, R2 = 0.997 respectively. The recovery percentages of prolactin (R %) in two methods were approximately equal to each other, VIDAS R%=50.52±0.89% and RIA R%= 50.38±1.57% respectively.
Conclusion: A highly significant positive correlation was found between RIA and VIDAS for both total and free serum prolactin. And high linear regression equations were found between the two methods to predict RIA values corresponding to a given VIDAS value.

Keywords: VIDAS prolactin, RIA prolactin, PEG precipitation, macroprolactinemia, uterine fibroid

Background: Breast cancer incidence differs among women of different racial/ethnic groups. Several HLA alleles are associated with susceptibility or protection in Breast cancer, the particular allele varies depending on the racial groups.
Objectives: This study was established to shed light on the possible association of HLA class II alleles with BC in Iraqi female patients.
Subjects and Methods: The study included 60 subjects: 30 breast cancer patients, 12 patients with benign breast lesions as first control and 18 apparently healthy subjects as second control. Polymerase chain reaction-specific sequence primers (PCR- SSP) assay was conducted to assess HLA- typing.
Results : A survey of the distribution of HLA-DR and HLA-DQ alleles frequencies yielded no evident of positive association between class II alleles and BC as compared with both control groups, but there was appreciable significant decrease in the frequency of DR*010101,0102,0201-0204,04-13 and DQB1*0401,02 alleles in BC patients as compared with healthy control (P=0.031).
Conclusions: These findings demonstrated that HLA– DR*010101, 0102, 0201-0204, 04-13 and DQB1*0401, 02 alleles may confer protective effects against BC.
Keywords: Breast cancer, HLA allele, PCR.

Background: Proplast is a material designed for tissue implantation commercially available through the Dow-corning Corporation. It is a gray black laminated felt of vitreous or glassy carbon and Teflon (polytetrafluoroethylene). The vitreous carbon also called hyperpure or elemental carbon or pyrolytic graphite, a pure molecular form of carbon that is pyrolytically derived from hydrocarbon such as rayon. Proplast was 1st prepared by Homsy in 1970, invented in 1968 especially for surgical implantation. It's manufactured as a tin felt sheet which is then layered and rolled under high heat and pressure to form the laminated block in common clinical use.
Objective: To evaluate the Proplast implant material in restoration of facial bony contour.
Methods: There were a total of 18 cases with proplast implant insertion. The mean age of the patients was 27.9 years. The range was 18-35 years. Data was obtained by prospective study and follow-up records of patients with the proplast implant at the department of maxillofacial surgery at Al-Kadhimiya Teaching Hospital for 6 years follow-up duration from 2000-2006.
Result: Proplast is a useful implant material for the restoration of facial bony contour (success rate was 88.9%). Sixteen implants were judges to be stable (88.8%), and 2 implants (11.2%) were judged to be unstable (removed) due to infection. In the two infected cases the fixation was done by wire fixation instead if suture fixation or spontaneous fixation with an intraoral approach. Of these 16 stable implants 3 were mobile (18.75%) and 13 implants were immobile (81.25%), and this is appeared to depend on the technique of proplast insertion.
Conclusion: Proplast is a useful implant material for the restoration of facial contour, There are some technical difficulties, when it is inserted over areas that are convex such as the malar prominence and orbital margins, in that it is difficult to eliminate the edge effect, but this can be overcome by proper feathering of the edges of the implant with a sharp scalpel.
Key words: Proplast, porous, alloplastic, implant.

Background:Toxoplasmosis, rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV) (TORCH), that can cause illness in pregnant women and may cause birth defects in their newborns. These entire infectious agents induce a shift of immune response during pregnancy from Th2 to Th1 and apoptosis which can be observed clinically as an abortion process.
Objective: To find out the significance of TORCH infection in patients with recurrent spontaneous pregnancy loss.
Materials and method: A total of one hundred and nineteen women, ranged from the mean age (23.9 − 28.5)years, were enrolled in the current study and were further classified into three categories: Group A- Recurrent spontaneous abortion (RSA): n= 62 women, with a mean age of (28.5 + 0.68);Group B- non- recurrent spontaneous abortion (non-RSA): n= 34 women, with a mean age of (26.4 ± 0.85)and group C- Control (successful pregnancy): n= 23 women, with a mean age of (23.9 ± 0.88). From each patient and control, blood sample was collected. Enzyme linked immune sorbent assay (ELISA),using anti CMV/IgG and IgM ,Rubrlla/IgM/IgG ,HSV/IgM and Toxoplasma/IgM/IgG was used.
Results: the current study revealed a significant difference in the levels of each of Toxoplasma gondii as well as Cytomegalovirus specific circulating IgM antibodies between group A and group C (p< 0.05) based on their respective enzyme linked immuno sorbent assay (ELISA)
Conclusion: In TORCH infections, there was a significant difference between RSA and control in acute infection of T.gondii and in the primary infection of CMV.

Key words: Torch,Recurrent Spontanious Abortion,Elisa

Background:The basic idea of aphaeresis is efficient removal of a circulating blood component, either cells (Cytopheresis) or plasma solute (plasmapheresis, plasma exchange).Thus, the treatment goal of aphaeresis is to remove the circulating cell or substance directly responsible for the disease process by automated cell separators in that ensure selectively removal of one or more of blood components from the blood and return the remainder to the individual. Plasmapheresis is separation of plasma from blood cells which are returned to the body. It is accompanied by changes in many haemostatic parameters were found when two different replacement fluids were used.
Objective:To determine the effect of:
1. Therapeutic Plasma Exchange (TPE) on selected parameters of hemostasis with each
Replacement fluid used and comparing between the effects of the two solutions.
2. Total volume of Plasma Exchanged (PE), spacing between sessions and number of sessions on coagulation screening tests.
Patients and Methods:This clinico-haematological study was conducted during a period of six months , from February 2004 to July 2004 at the National Blood Transfusion Center / Baghdad & 50 patients underwent Therapeutic Plasma Exchange for various disorders for 3-12 sessions with two different replacement fluids were used & two types of automated blood cell separators(Haemonetics MCS plus & Fresenius AS.TEC 204) were applied. Venous blood samples were collected immediately before & after the first session & after the last session. Control group of 20 persons were included in this study.
Results: The changes in Prothrombin Time, Partial Thromboplastin Time, Thrombin Time, Fibrinogen, Platelets count, Haemoglobin and Packed Cell Volume were significant after TPE. There was no significant difference in changes in crystalloid group from that in Fresh Frozen Plasma (FFP) group. In crystalloid group, significant correlation was observed between Prothrombin Time, Activated Partial Thromboplastin Time, Thrombin Time & volume of PE /session, while spacing between sessions and the number of sessions was significantly correlated with Thrombin Time. Plasma fibrinogen concentration and platelets count were decreased in the patients included in this study.
Conclusion: There is no significant difference in changes in haemostatic system whether crystalloid or diluted FFP was used as replacement fluid. Thus, crystalloid, solution devoid from coagulation material can be used as a replacement fluid in the TPE if the volume of PE is small which will minimize the usage of blood components as a safer replacement fluid substitute.

Key words: fresh frozen plasma, therapeutic plasma exchange.

Background: Rapid cytological diagnosis of various tumors and especially that of breast was first introduced by Dudgeon and Patrick 1927.The accuracy of the imprint method has been increasing over the years both in breast pathology and in other body sites, indeed the average accuracy of (90-94%) in the past has reached (97-98%) in recent years.
Objective: A prospective study was performed to determine the value of this technique in the diagnosis of male and female patients with various breast lesions.
Methods: From June 2005 and February 2006 Imprint cytology was obtained from (110) specimens of (107) patients with various breast lesions in Sulaimania teaching hospital.
Cytological examinations of imprints stained by hematoxiline and eosin stain were examined and compared to histological results to detect its sensitivity, specificity and accuracy rate.
Results: The sensitivity and specificity of imprint cytology for both benign and malignant breast lesions were 96.3% and 100% respectively; while over all accuracy was 98.9%. False negative diagnosis was seen in a single case of Paget’s disease of the nipple (0.9%); however no false positive cases were found.
The cytological diagnosis were malignant in 26 cases (23.7%), including (25) primary malignant tumors and (1) metastatic carcinoma, benign diagnoses were encountered in 71 cases (64.5%), suspicious in 4 cases (3.6%) and unsatisfactory in 9 cases (8.2%).
Conclusion: Imprint cytology is simple, rapid, inexpensive and accurate method for intraoperative diagnosis of breast lesions and can be used as adjunct to frozen section.

Key words: Imprint cytology, breast lesion

Background: Honey has been reported to have an inhibitory effect to around 60 species of bacteria including aerobes and anaerobes, gram-positives and gram-negatives.
Objectives: The aim of this study was to investigate the antimicrobial activity of honey sample from Basrah region against certain bacterial isolate.
Method: different concentrations (25.0%, 50.0%, 75.0% and 100.0%) of honey sample where checked for their antimicrobial activities, using some medically important microorganisms including Escherichia coli, pseudomonas spp. and staphylococcus aureus. The minimum inhibitory concentrations (MIC) of the honey sample were determined on the selected microorganisms by using broth dilution technique
Result: The sample of honey show inhibitory effect in vitro at 50%, 75% and 100% concentration on the various investigated microorganism except at 50% concentration where no inhibition zone on Staphylococcus aureus. However, no effect was observed at concentration 25%. The MIC for Escherichia coli, pseudomonas spp. and staphylococcus aureus were 6.25mg/ml, 1.5mg/ml and 12.5 mg/ml respectively. Conclusion: The study shows that honey, like antibiotics, has certain organisms sensitive to it, and provide alternative therapy against cretin bacteria. And shown to have an antimicrobial action against a broad spectrum of bacteria (both gram positive and gram negative bacteria).

Key words: Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, honey, antibiotics, sensitivity, antimicrobial.

Continuous urine dribbling together with normal micturition is the classical picture of ectopic ureter in girls. We present our case which 22yr old lady presented to our department with life time incontinence. The diagnostic work-up included: Excretory Urography, ultrasonography (US), cystogram, MRI and Cystoscopy, as well as a thorough exam of the external genitalia under general anesthesia. Our case presented an ectopic ureter that ends the vagina with single dysplastic renal system and nephrectomy with ureterectomy was done as treatment of choice. Urinary incontinence in girls due to ectopic ureter is an uncommon disease. Eighty-five% of the cases are associated to renal duplication. IVU is highly sensible to defect renal duplication; and only 15% of ectopic ureters come with single system.

Keywords: incontinence, ectopic ureter, duplex renal system

A case of retroperitoneal perforation of the appendix presenting with a thigh abscess is described.
Keywords: Complicated acute appendicitis, retroperitoneal perforation, retroperitoneal abscess, Thigh abscess