IRAQI JOURNAL OF MEDICAL SCIENCES

Background: Distal Fracture of the radius in children-sometimes (erroneously) called ‘Juvenile colles’ is among the commonest sites of childhood fractures. Cases with completely dorsally displaced fracture of distal radial metaphysis were collected, evaluated, and treated with either closed reduction or closed reduction with K-wire fixation.
Objective: is to evaluate the advantage of percutaneous K-wire with cast immobilization over cast immobilization alone in management of displaced distal metaphyseal fracture in children and adolescent below 15 years with respect to maintenance of reduction and Join Motion.
Methods: In this study 34 children all sustained completely displaced distal metaphyseal fracture of the radius were divided into two groups:
Group A consist of 16 children (10 boys and 6 girls), with a mean age 7.9 years. Group B consist of 18 children (11 boys and 7 girls), with a mean age 8.6 years.
In both groups reduction was achieved by closed method under general anaesthesia and image intensifier and reduction was easily achieved beyond 70% of cortical contact and less than 15°of angulation.
For group A: the fracture was immobilized by complete above elbow cast. For Group B: the fracture was immobilized by insertion of a percutaneous K-wire across the fracture with complete above elbow pop cast. The patients (in both groups) were discharged from the hospital in the second postoperative day. The patients in group A reviewed once weekly for the first 3-4 weeks with anteroposterior and lateral radiographs and four children (25%) of this group was complicated by redisplacement of the fracture, three of them required remanipulation under general anaesthesia, while in group B the complications rate were low regarding redisplacement and there was no need for remanipulation. These patients were reviewed every 3 weeks and X-ray exposure was low. The union rate in both groups was the same.
Results: Risk of displacement was greater in group A (25%) compared with no displacement in group B. Pin track infection in group B occur only in one case (5-6 %) regarding limitation of pronation supination and dorsiflexion (as compared with uninjured side )in both groups ; for group A wrist flexion 35°(58.3% of normal range )while pronation- supination was 40° (44.4% of normal range ) for group B wrist flextion 40°( 66.4% of normal range ) and pronation _supination was 55°( 61.1% of normal range.
Conclusion: supplementary percutaneous K –wire fixation results in better maintenance of alignment, reduces the need for follow up radiographs and the need for further procedures to correct loss of position.
Keywords: completely displaced fracture left radius, cast, K-wire.

Background: Glucosyltransferase is an extracellular enzyme produced by mutans streptococci responsible for polymerizing the glucose moiety of sucrose to form glucan.
Objective: Isolation and purification of glucosyltransferase from mutans Streptococcus sobrinus.
Methods: The enzyme was purified from mutans Streptococcus sobrinus by
ultrafiltration , adsorption chromatography, ion-exchange by DEAE-cellulose and gel filtration by Sephacryl S-200.
Results: Large scale production, concentration and purification of mutans streptococci (S.sobrinus) (serotype G) N10 glucosyltransferase (GTF) were done by ultrafiltration-method using an Amicone-filter P50,adsorption hromatography (hydroxyapatite beads), ion-exchange chromatography (DEAEcellulose column) and gel-filtration chromatography using (Sephacryl S-200)column. Three purified GTF enzymes (GTF-Ia,GTF-Ib, GTF-II) were detected with a specific activity of (31.60; 31.50 and 66.270) Unit/mg protein respectively and the fold of purification are (27.59; 27.92 and 58.75 respectively with yield of enzymes (14; 10.94 and 17.11 %) respectively.
Conclusion:The purified enzyme with accepted yield may open new approaches for its using in oral passive immunization against dental caries in experimental animals by using hen egg yolk antibodies specific for cell associated GTF of mutans streptococci bacteria.
Keywords: glucosyltransferase , Streptococcus sobrinus, purification, adsorption
chromatography.

Background: Renal cell carcinoma (RCC) is the commonest renal malignancy, comprising 85-90% of all malignant renal tumours and represents 3% of all adult malignancies. The prognosis of RCC depends on the size, stage, and grade of the tumor. CT has proved to be the most important imaging technique for the evaluation of renal lesions and the preoperative staging of renal cell carcinomas.
Objective:The aim of our study was to evaluate the accuracy of spiral CT in the preoperative assessment of patients with renal cell carcinoma correlated with histopathological findings.
Patients and methods: Between February 2008 and September 2009, a prospective study included 40 patients (age range, 36–66 years; 28 men, 12 women) with solid renal masses. All the patients were diagnosed by CT as having renal cell carcinoma, underwent total nephrectomy & proved to be renal cell carcinoma at histopathlogical examination. In all patients, initial CT images were obtained without administration of contrast material, 100ml of Intravenous contrast material was administered, a repeated scan was done 120 seconds after contrast injection, both scans should covered the entire volume of the abdomen. Percentage of the parameters used in the study was calculated. Diagnostic accuracy of CT in staging renal cell carcinoma was calculated.
Results: The study included 40 patients (28 men, 12 women) with solid renal masses. Tumor size ranged from 1.7 to 6.5 cm (mean size, 3.1 cm). All the patients showed evidence of contrast enhancement by about 47HU.
Thirty seven patients (92.5%) show heterogeneous enhancement while only 3 patients (7.5%) show homogenous enhancement. Calcification was seen in 10 patients (25%). A pseudocapsule was present in 16 patients. Lymph node (LN) involvement with adenopathies larger than 1 cm in diameter was found in 7 patients (17.5%), only one patient (2.5%) show false negative diagnosis, the over all diagnostic accuracy of LN detection was 83%. Renal vein or inferior vena cava thrombosis was detected in 8 patients (20%), diagnostic accuracy was 87.5%. The overall diagnostic accuracy of CT in staging renal cell carcinoma was 90% (36 out of 40).
Conclusions: CT is an excellent imaging technique for the evaluation of solid renal masses and the preoperative staging of renal cell carcinomas. CT has some difficulty in differentiating T3a from T2. CT has a limited ability to identify lymph node involvement by malignancy because it is still based on only size criteria, with 10 mm as the limiting size for normal nodes.
Keywords: Spiral CT, pre-operative staging, renal cell carcinoma.

Background: A retrospective study on neonatal deaths was done in the Medico-Legal Institute of Baghdad.
Objective: To differentiate stillbirths from lived ones and to know the causes of death in the last group.
Methods: Full autopsy examination was done on all the (17) cadavers of neonates that had been sent to medico-legal institute of Baghdad for six months duration from 1-10-1996 to 31-3-1997, in addition to the required laboratory investigations. The results were converted into tables and figures.
Results: Neonatal deaths constituted 6.37% of the total number of pediatric medico-legal mortalities up to 12 years old during the period of the study. The highest percentage of neonatal deaths was in February 1997.The number of the lived births was slightly higher than stillbirths with no significant statistical difference. Bronchopneumonia was the first cause of death in the lived births. In addition to the other results of the study.
Conclusion: The prevalence of neonatal deaths is low in Baghdad (During the period of the study) especially the criminal ones with the medico-legal and social importance of that.

Key words: Medico-legal, Neonatal, Deaths.

Background: Mesenchymal stem cells have capability for proliferation, self renewing, and differentiation into different types of cells in
vitro and the medical potential use of these cells is in tissue replacement therapy.
Objective: This study aimed to isolate and cultivate mesenchymal stem cells (MSCs) of adult albino rats Rattus rattus norvegicus albinus and enhancement their growth,proliferation and maintainance in active state for several weeks.
Methods: The successively passaged cells were exposed on the second day of cultivation to the Minimum essential medium (MEM)with 5-azacytidine at a concentration of 10μmol/L.
Results: The results of in vitro study showed that the mesenchymal stem cells showed fibroblast like morphology appearance before 5-azacytidine treatment, but its morphology began to change after 5-azacytidine treatment in about 50% of the adherent cells. These cells were connected with adjoining cells after one week and began to form myotube-like structures at the end of the second week. The immunocytochemical staining demonstrated that the differentiation of mesenchymal stem cells into cardiac-like muscle cells, which was detected by using specific marker (anti-cardiotin),expressed positive response for this marker.
Conclusion: Rat mesenchymal stem cells can be extensively expanded in vitro and chemical–induced cardiomyogenic differentiation by 5-azacytidine treatment.
Key words: Bone marrow stromal cells; Proliferation; Differentiation; 5-azacytidine; Cell culture

Background: Delirium is a syndrome characterized by the rapid onset of variable and fluctuating changes in attention resulting in disturbed behavior, illusions, hallucinations & changing level of consciousness caused by physiological consequences of a medical disorder, its prevalence is estimated to be bout 15-20% of general medical wards.
Objectives: The aim of this study is to measure the prevalence of delirium in patients admitted to medical wards and to study signs and symptoms of delirium.
Methods: A cross sectional study of all patients who were admitted to the medical wards of Al-Kadhimiya Teaching Hospital in Baghdad during the study period which is from 21 March 2008 to 21 April 2008, the total admissions were 510 patients, with excluding criteria: a pre-existing psychiatric disorder and age less than 18 year.
- Approval to the questionnaire was taken from the relatives.
- All patients with delirium were referred by residents during the study period - Delirium cases were diagnosed according to DSM IV criteria; prevalence was estimated and symptoms studied
Results: The prevalence of delirium was about 3% among the medical inpatients.
Conclusion: The prevalence of delirium reported in this study is low in comparison to other studies. This is explained in terms of difference of methodology used in this study in comparison with other studies.
Key words: delirium, inpatients, medicine

Background:Correction of anemia as a result of renal failure improves cardiovascular function and also provides significant cognitive and emotional benefits.The most appropriate route for iron supplementation has not been determined for patients with chronic renal failure who are not y et on dialysis.
Objective:It is to compare the efficacy and tolerability of oral and intravenouse iron as an adjuvant therapy for erythropoieten treated anemic patients with chronic kidney disease in predialysis state.
Methods:Forty five anemic patients with chronic kidney disease where prospectively randomized to receive an oral (ferrous sulfate 200 mg three time dialy ), or intravenous (300 mg iron dextran/ monthly) iron treatment, the duration of treatment was six months.
Erythropoietin (rHuEpo) was simultaneously commenced and the dose adjusted according to pre-established protocol.
Results:There were no significant differences in baseline patients characteristics between the two groups. four patients suffered possible
allergic reaction to iron dextran. Hemoglobin response in the end of study was similar in two groups, but serum ferritin was significantly higher in the intravenous group.the Starting dose of rHuEpo temporarily discontinued in the patients on oral iron and the patients receiving iron dextran rHuEpo was increased after 3 months , final doses on EPO were (33.5) and (41.6) units /Kg/week respectively in the oral and intravenous group. Although gastrointestinal symptoms were more commonly reported in patients taking oral iron.
Conclusions: In pre-dialysis patients; the efficacy of monthly 300 mg iron dextran administerd intravenously is not superior in regard to haemoglobin response and EPO dose as compared with daily oral dose of 300 mg of ferrous sulfate or equivalent.
Key words: Chronic renal failure,
Erythropoietin, Dialysis, Ferritin , Iron dextran

Background: Polythelia or supernumerary nipple (also called third or accessory nipple) is an additional nipple occurring in mammals including humans. These additional nipples develop during embryonic life as part of abnormal development of mammary glands.
Objectives: To describe the polythelia and it’s most frequent locations also to give a perspective of polythelia in a series of observations. And lastly to asses if there is any genetic inheritance present.
Methods: Forty three cases of polythelia were collected from attendants of general practice clinic in Baghdad. The polythelia was observed during routine physical examination, which included examination of the chest and abdomen.
Results: From 43 cases of polythelia, males constituted 23 (53.5%) of cases. Regarding the anatomical location of polythelia, 2(4.65%)were on the anterior axillary fold, 28(65.1%)on the anterior thoracic wall, 12(27.9%) on the anterior abdominal wall and one (2.3%) was in the inguinal region. Only five cases (11.6%)had family history of previous similar conditions.
Conclusion: Polythelia is a fairly common abnormality. Men and women may have extra nipple, but no significant difference was detected that can be related to gender difference. Nevertheless presence of extra nipples was sometimes linked to heart disease, no such relationship was noticed. All cases in this study had their polythelia along the milk line. Nevertheless, there had been reports on polythelia presenting as far away as the foot.
Keywords: polythelia, mammary gland, Supernumerary nipple.

Background: Denture cleanser should be designed to remove and prevent re
accumulation of microbial plaque. Cleaning the denture by chemical immersion have several advantages that solutions reach all areas of the denture and results in complete cleaning. One problem associated with their use has been bleach and discoloration the surface layer of acrylic dentures.
Objective: to assess the color alteration of heat polymerized acrylic resin after immersed in different types of chemical denture cleanser.
Method: forty five rectangular specimens (50x3.5x3mm) (length-width-thickness) of heat activated acrylic resin were divided in three denture cleansers groups (sodium hypochlorite NaOCl 0.5%) and vinegar (acetic acid 6%) and control group (immersed in distal water). Soaking trial 8 hours simulated 30 days of use. Color alterations were assessed by visual examination of photographs and by spectrophotometer testing device.
Results: the results of spectrophotometer testing device did not show any interaction between different type of chemical cleansers and acrylic resin during 30 days 8 simulated use, also visual examination did not detect any color alteration.
Conclusion: denture clearers, when used according to the manufacturer’s instructions, did not cause any mechanical or visual alterations in the heat polymerized acrylic resin.

Keywords: Acrylic resin – denture cleansercolor
changes.

Background: Wound healing is a complicated, interactive, integrative
process involving cellular and chemotactic activity, the release of chemical mediators and associated vascular response which includes number of phases: inflammatory phase, proliferative phase and remodeling phase. Low level laser therapy can be more effective in the three overlapping phases of wound healing. Biostimulation appears to have an effect on the cellular level, by increasing cellular function and stimulating various cells.
Objective: To evaluate the efficacy of low level diode laser on wound healing of human skin clinically.
Patients and Methods: This study was performed on 20 patients (10 male, 10 female) age range between 5-75 years with oral and maxillofacial lesions underwent maxillofacial surgery with low level laser therapy. After the surgical intervention, the wounds were divided into two parts,
one part was irradiated by 1.25 W/cm2 power density, 50 sec. exposure time low level diode laser and other part was left as a control. The postoperative course was evaluated based on subjective scale of edema, redness at 2nd -5th day postoperatively.
Results: Clinical evaluation of edema and redness were recorded at 2nd -5th day. Edema was obviously reduced in laser treated wounds in 14 patients. Redness was slightly increased in laser treated wounds in 15 patients. Finer scar in laser treated wound appeared as compared with wide scar in control wound.
Conclusion: Low level laser therapy causes edema-reducing effects and a little effect on a neovascularization at 2nd day after surgical intervention and minimal or fine scar formation.

Key words: Wound healing, Biostimulation, Low level laser therapy.

Human umbilical cord blood (UCB) contains hemopoietic stem cells (HSCs)
which are regarded as valuable sources for cell transplantation.
Objective:This study is aimed to identify a class of human hemopoietic colony –forming cells and found the suitable concentration for replating experiments.
Methods: Cord blood (CB) was collected from placenta of newly delivered women in Al-Kadhimiya Teaching Hospital in Baghdad for normal vaginal delivery. Isolation and culturing of cells took place in Medical Research Unit College of Medicine Al-Nahrain University.
The present study included two lines:- A:-Immunocytochemistry analysis of mononucleated cells (MNC s) for CD34. B:-Culturing MNCs in different concentrations in order to determine the suitable concentration for replating further experiments. Mononucleated cells were isolated by using density gradient centrifugation and the MNCs count and viability were determinated by using trypan blue.The MNCs were cultured in RPMI +10%FCS and the medium conditioned by 1%(v/v) phytohemagglutinin (PHA).The cultures were maintained in an environment of 37C٥, 5%CO2 and fully humidified atmosphere for 14 days.
Results: The results of immunocytochemical staining showed that MNCs were positive for CD34+,the conditioned medium gave rise to hemopoietic colonies containing colony forming unit –granulocyte-macrophage(CFUGM)
, burst forming colony- erythroid (BFUE)and mixed colonies(CFU-EMM).These colonies could be distinguished from other hemopoietic colonies in situ by the complete absence of signs of terminal differentiation.
Conclusions: The results of this study confirmed that UCB provides a great source of hemopoietic stem cells for using in medical applications.