Iraqi Postgraduate Medical Journal

Children's acute diarrhea is an extensive global problem .It has increased in Iraq seventeen fold after
wars and economic sanctions. Proper management is important in saving lives and prevention of
complications. We wanted to see what drugs were used, how often and how it compared with oral
rehydration use.
METHOD:
The mothers of 175 children who presented with diarrhoea of acute onset and admitted to the
Children Welfare Hospital, Baghdad, over a period of 8 months were interviewed.
RESULTS:
Apart from 39 children, who had parenteral infections, two had celiac disease and one accidentally
ingested a laxative, the others were diagnosed as gastroenteritis at hospital. Of the 102 children
diagnosed as gastroenteritis before admission, 29(28%) had their stools microscopically examined
and a parasite was found in 12. Seventy- three (75%) of those who did not have stools examined, and
(59%) of those who had no parasites demonstrated in stool were given antibacterials (metronidazole,
gentamicin, amoxycilin, +/- cloxacilin, co-trimoxazole). Many had antiemetics and anti spasmodics.
Oral rehydration solution (ORS- WHO) was given to (46%) of patients.
CONCLUSION:
Seventy-Four (73%) of children with gastroenteritis were given anti bacterials at home and less than
half had ORS.

Interleukin-1α and Interleukin-8 are an inflammatory cytokines. They are a heterogeneous group of
humeral mediators of the inflammatory response. In leukemic patient's leukopenia developed as a
result of cytotoxic chemotherapy and/ or disease itself. Therefore, those patients were suffering from
low number of leukocytes in addition to defects in the function of these cells. Normally leukocytes
are the main source of cytokines production.
METHODS:
IL-1α and IL-8 were studied in (84) adult patients, males and females and more than 15 years old.
The leukemic patients were suffering from leukopenia and bacteremia. The study including (20)
healthy. Interleukin-1α and interleukin-8 concentrations were measured by using a commercially
available enzyme-linked immunosorbent assay (ELISA).
RESULTS:
Statistical analysis shows significant increase in the levels of IL-1α and IL-8 between leukopenic
leukemic patients with bacteremia and healthy control group.
CONCLUSION:
Leukopenic leukemia patients strikingly show distinct increases in plasma IL-1α and IL-8 levels
during bacteremia.

The frequency of acute respiratory failure is higher in infants and young children than in adults.Acute
respiratory failure remains a significant cause of morbidity and mortality for children .
PATIENTS AND METHODS:
One hundred and twenty children under the age of 15 years presented with respiratory failure and
admitted to RICU in Children Welfare Teaching Hospital and Surgical Specialty Hospital in Medical
City - Baghdad in the period from the 1st of May -2003 to the 30th of June 2005 were enrolled in a
descriptive study.
RESULTS:
Seventy nine (65.83%) cases were males and 41 (34.17%) were females. Male / female ratio was
1.93:1.The mean age was 30.21 months, 35 (29.16%) cases were neonates. Sixty eight (56.7%) cases
were from urban areas and 52 (43.3%) were from rural areas. Seventy eight (65%) children were
admitted for medical diseases and 42 (35%) were admitted for surgical problems. The most common
medical causes were respiratory (50%) followed by neurological (37. 17%).The most common
respiratory cases were bronchiolitis (28.2%) and most common neurological cases were Guillain- Barre
Syndrome (58.6%).The majority (90.47%) of surgical cases were admitted post-operatively. The
average duration of stay in RICU was 9.71 days. Fifty three patients (44.17%) survived and 67
(55.83%) died.
CONCLUSIONS:
The most common age group admitted to RICU is infancy, medical cases are more commonly admitted
than surgical cases, the most common medical causes of admission are respiratory followed by
neurological causes, the most common respiratory cause of admission is acute bronchiolitis.

To show the role of enhanced spiral computed tomography in clinically suspected acute pulmonary
embolism(PE) patients .
PATIENTS AND METHODS:
From October 2003 to October 2004, Fourty two patients with clinically suspected acute pulmonary
embolism ,were examined by thin slices contrast enhanced spiral computed tomography as the primary
diagnostic test to role out or confirm the diagnosis of pulmonary embolism. Patients were examined in
the Radiology Departments of (Al-Kadymia, Al-Yarmook & Ibn Al-Bittar Teaching Hospitals).
RESULTS:
Pulmonary embolism diagnosed in 43% of the patients by showing clot within pulmonary arteries with
or without non specific signs like effusion , wedge infarct & dilated pulmonary artery .CT was normal
or gave an alternative diagnosis that could explain the patient’s signs & symptoms in 52%.
Inconclusive findings were seen in 5%.
CONCLUSION:
Computed tomography can be used safely as the primary diagnostic tool in clinically suspected acute
pulmonary embolism patients, to confirm or role out the diagnosis.

Gallstone disease is a common condition all over the world as well as in Iraq. Symptomatic gallstones
definitely need surgical or medical treatment . To remove or treat silent gallstones is still a debatable
subject. Gallstones are about twice as common in women than in men and their incidence vary
according to some physical fasters
METHODS :
1016 adult volunteers from both sexes and of different age groups were examined by ultrasound in
Medical city teaching hospital between January 2004 and August 2005, for the estimation of the
prevalence of silent gallstones among Iraqi people and it's relation to some physical and familial
factors was studied .
RESULTS:
The incidence of silent gallstones in both sexes was 3.3%. It is more common in women 4.09% than in
men 2.2% and it increases with age, parity, and the use of contraceptive pills, and high intake of black
tea The size of most of the stones was less than 20 mm and they were less than three in number, the
gall bladder was with a normal wall thickness, no associated mass , or gallbladder wall calcifications,
and no association with specific blood group or obesity was found.
CONCLUSIONS:
Silent gallstones were found in 3.3% of healthy Iraqi individuals, and they are associated with the same
risk factors of symptomatic gall stones such as age , parity , familial contraceptive except that obesity
and blood groups are not a major risk factor.

Hypertension is a world wide disease and in 90% of cases the cause is unknown . Its early detection
and treatment can prevent serious complications such as ischemic heart disease (IHD) . Furthermore
the association of lipids with IHD is a well-known fact . However abnormally high levels of
homocysteine were found to be strongly linked to an increase risk of coronary artery disease .
OBJECTIVES:
To evaluate the total plasma homocysteine concentration in hypertensive patients.
METHODS :
Total plasma homocystein concentrations were measured using High Performance Liquid
Chromatography(HPLC) with Ultraviolet( UV) detector in 60 hypertensive patients (27 male and 33
female) aged 35 years and more . Cholesterol , triglyceride , HDL-cholesterol , LDL-cholesterol ,
VLDL-cholesterol were determined .The prevalence of high total homocysteine values were determined
by comparison with normal reference population.
RESULTS :
Total plasma homocysteine levels were significantly higher in patients than in normal population. Total
serum cholesterol and triglyceride concentrations were also significantly higher in patients than in
normal population with no association to the level of homocysteine which is regarded as a special
independent vascular risk factor.
CONCLUSION :
The study involves the evaluation of homocysteine in hypertensive patients plasma homocysteine
levels were significantly higher in patients than in control groups. There were no significant differences
between male and female patients.

Cancer of breast is by far one of the most important clinical problems that concerns the surgeon. It is
the commonest form of cancer in females, when detected early and given the proper treatment can be
cured. Color Doppler imaging is modern technique that can be used in preoperative assessment of
breast lumps.
OBJECTIVE :
To asses the role of color doppler imaging in differentiating malignant from benign breast lumps in
comparison with the histopathology in AL- Najaf teaching hospital.
METHODS:
Total number of patients was 80 female of different age groups were assessed during the period from
first of February 2004 to the first of February 2006 , presented with variable palpable breast masses.
After clinical assessment, all our patients underwent , color doppler imaging and then subjected to the
excisional biopsy and histopathology for confirmation of the diagnosis.
RESULTS:
The results of color doppler imaging for all our patients were found as follow, benign lumps in 54
cases (67.5%),malignant lumps in 26 cases (32.5%),two cases diagnosed as benign by color doppler
imaging proved to be malignant by histopathology
giving ( 2.5%),false negative rate. All obtained results of sensitivity, specificity and over all
accuracy of color doppler imaging respectively as follow (92.85%),(100%),and(97.5%).
CONCLUSION:
Color doppler imaging is highly sensitive and specific method in evaluating malignant breast masses
and is painless, non-invasive and time saving procedure, so we can reduce the rate of unnecessary
surgery for histopathology.

A prospective study of Splenectomy personal experience,with changing pattern of indications.
METHOD:
During the study period (Feb, 1990-Jan, 2006), a total of 411 splenectomies performed in erbil
governate for different indications.
RESULTS:
The study included 411 patients, the age rang were 4– 65 years. Out of 411 cases 201 cases were due
to trauma (48.9%).
CONCLUSION:
Trauma of different types remains the most common indication for splenic surgery & complications
like gastric or pancreatic fistula is historical complications.

Soft tissue war injuries of the upper limb are usually extensive and multiple . Plastic surgeons face
the challenge of reconstructing these injuries in patients who are multiply injured ,and in a time when
facilities for free flap surgery are not available.
OBJECTIVE:
To demonstrate the efficacy of random abdominal flaps in reconstructing soft tissue defects of the
upper limb.
METHODS:
From May 2003 to September 2005, 55 war injury patients with deep soft tissue loss in the upper
limb were managed by random abdominal flaps of different shapes and directions, 13 of them had
other soft tissue injuries affecting other areas in the body. The surgeries were done in busy general
hospitals during war where time, personnel and facilities are limited.
RESULTS:
In 53 patients, the flaps had completely survived without complications, 2 flaps developed partial tip
necrosis and healed later by secondary intention. Donor areas were covered by split thickness skin
grafts in 52 cases, and directly closed in 3 cases. The largest flap dimension was 18 cm length and 15
cm width. The main disadvantages of the flap are donor site scar, bulk of the flap, and the need for a
second stage for flap separation.
CONCLUSION:
Random abdominal flaps are easy, safe, versatile and operative time saving option for coverage of
upper limb injuries. It can be designed in any direction to cover different soft tissue defects. These
flaps still continue to be an excellent alternative for free tissue transfers during war time.

Shoulder pain is one of the complications that happened in patient suffered of hemiplagia our aim is to
study this problem in hemiplegics patients due to stroke
METHODS:
56 patients affected by different types of stroke were enrolled in this study , each patient was
examined by neurologist , CT scan then done and referred to a consultant rheumatologist at alkindi
hospital for assessment of his shoulder area , the patient then investigated thoroughly for his or her
shoulder pain
RESULTS AND CONCLUSION :
The study showed high correlation between shoulder pain and older age patients, aphasia, cortical
sensory defects
The study showed that the frozen shoulder is the commonest cause of post stroke shoulder pain

Soft tissue war injuries affecting the lower half of the leg are a major challenge facing plastic
surgeons .Distally based fasciocutaneous flaps have an important role in the management of these
defects.
OBJECTIVE :
To demonstrate the role of distally based fasciocutaneous flaps as an alternative to free tissue transfer
in the management of lower leg soft tissue defects.
METHODS :
Thirty seven war injury patients with soft tissue loss in the lower half of the leg were managed by
distally based septocutaneous flaps (19 cases),and distally based superficial sural artery flap (18
cases) , donor areas were closed by partial thickness skin grafts in all of the cases.
RESULTS :
All of the 37 flaps survived and healed uneventfully except in 4 cases in whom partial necrosis of the
flap occurred at the tip. Two cases of distally based superficial sural artery island flaps developed
venous congestion and edema .
CONCLUSION :
Distally based fasciocutaneous flaps are an important alternative to microvascular tissue transfer in
treating lower leg war injuries. The versatility and arc of rotation of the distally based superficial
sural artery flap were better than in distally based septocutaneous flaps.

Visceral leishmaniasis is an endemic disease in Iraq with high incidence among children below two
years. Some recent reports indicated a immunopotentiation role of peganum harmala seed extract
against some intra cellular pathogen.
OBJECTIVES :
To investigate the immunostimulation effect of peganum harmala seeds extract before infection with
leishmania donovani in BALB/C mice through various parameter's .
METHODS :
BALB/C mice were divided into experimental groups with each group consisting of six animals . The
experimental groups injected introperitoneally with 5x106 promastigotes. Experimental groups were
injected intraperitoneally by peganum harmala seed extract at doses of (125 , 250 , 500) g/20gm b.
wt. On day 5,10 and successive six days before infection with L. donovani . These animal were
sacrificed after (8) weeks. Total parasite burden in spleen , liver percent of infected cells,
leishmancidal index in peritoneal macrophage, number of macrophage forming formazan.
RESULT :
Decrease in number of total parasite burden in liver and spleen in all mice groups treated with P.
harmala seed extracts also, decrease in percent of infected cells, increase in leishmanial index in
peritoneal macrophage, increase in macrophage forming formazan .
CONCLUSION :
Peganum harmala seeds extract was found to have anti leishmanial had anti leishmanial activity
through killing of leishmania donovani amastigotes by activated macrophages .

Penganum harmala is a well known herb that is used by different societies. It is used as a medical
herb in treating various diseases and disorders .There was no earlier published work on the effects of
the aqueous extract of Peganum harmala . Therefore, we designed this study to investigate the effect
of the aqueous extract of Peganum harmala seeds on the mammary gland at the various physiological
states (virgin, pregnancy and lactation) making use of the available histological, histochemical, and
immunohistochemical means.
METHODS:
Aqueous extract of Peganum harmala was given for two weeks by an orogastric tube on single regular
daily dosage to Norway albino female rats. Animals were subdivided into subgroups according to
their physiological states. Mammary glands of these animals were routinely processed for histological,
immunohistochemical and histochemical studies using formalin fixative ,paraffin embedded sections
in the first two studies and formal calcium, frozen sections in the third study. Experimental specimens
were compared with that of control subgroups.
RESULTS :
Harmal induced mammogenesis in the mammary glands of virgin rats. It's aqueous extract was able to
initiate lactogenesis in a well-prepared mammary gland (i. e. during pregnancy) and finally this
aqueous extract promotes lactogenesis when administrated during lactation.
CONCLUSION :
Peganum harmala is a mmammogenic herb .

The aim of this study is to differentiate between virulence of two isolates ,one was isolated from
severe clinical symptoms of amebiasis isolate (A) the other was from asymptomatic carriers isolate
(B).
METHODS :
12 male hamsters were employed in this study , they were divided into 3 groups . 1st group (5
hamsters), inoculated intracecally with isolate isolate (A) from human case of severe amebiasis . 2nd
group (5 hamsters) inculated with isolate (B) from asymptomatic carriers .3rd group (2
hamsters)inoculated with saline solution as control group .
RESULTS :
1st group of hamsters showed a flask shaped ulcer with sever inflammation of cecum with liver
abscesses , after four weeks of infection The 2nd group showed only mild inflammation of cecum
without ulceration and liver abscess. While 3rd group were normal control group.
CONCLUTION:
Our study may be Considered as a step for Characterization of Entamoeba histolytica that cause the
invasive intestinal and extraintestinal amebiasis and E.dispar an intestinal commensal parasit in Iraq

Epstein-Barr virus (EBV) was ubiquitous Herpes virus that had a role in the development of
undifferentiated carcinoma of the nasopharynx, Burkett’s lymphoma, acute infectious mononucleosis
and other lymphoprolifrative disorders.
METHODS:
Thirty Iraqi patients with nasopharangeal carcinoma were referred to Oncology Unit in Al-Kadhemia
Teaching Hospital from 1992-1994. Sera of those patients were tested for the presence of antibodies
against Epstein-Barr virus nuclear and early antigens using indirect immunoflourescence test.
Cellular immunity for those patients was tested for the CD4+, CD8+, CD4/CD8 ratio, T-cells % and
B -cells %. Their results were compared with twenty-two normal apparently normal individuals.
RESULTS:
Antibodies to Epstein-Barr virus nuclear and early antigens were detected in nasopharangeal
carcinoma Iraqi patients and not in the control group. There was significant difference between two
groups in CD8+ cells, T- cells % and B- cells % and there was no significant differences between two
groups in CD4+ cells, CD4/CD8 ratio.
DISCUSSION:
EBV infection was stopped by T- cells immune response that was capable of eliminating virus
infected cells and virus neutralizing antibodies against nuclear and early antigens which prevent the
spread of infection. Lymphocytes were predominantly CD8+ cytotoxic T lymphocytes, which
recognize and destroy EBV infected cells.
RECOMMENDATIONS:
Other antibodies to viral capsid antigens (IgG, IgA and IgM). Other methods must be used other than
indirect immunoflourescense test like western blot method and enzyme linked immune sorbent assay
(ELISA)

Many previous studies revealed that salivary and serum IgA response to infectious agents such as
EBV-coded antigens in patients with nasopharyngeal carcinoma (NPC) had a vital role in the
combat against tumorigenesis. Moreover, it could be considered as a reliable index for the humoral
limb of anti-cancer immunological action.
METHOD:
One hundred twenty two head and neck cancer (HNCA) patients were selected randomly from two
main hospitals, Alkadhimya hospital and radiotherapy center in Baghdad. Also 100 apparently
healthy control subjects (HC) underwent the same examinations and tests. Enzyme-linked
immunosorbent assay (ELISA) test was applied on all HNCA patients sera and saliva, in order to
measure anti-EBV IgA antibodies .
RESULTS:
Revealed that NPC patients were the only group that showed a sero-positive ELISA readings of antiEBV serum IgA. No saliva EBV antibodies were detected in the studied groups .
CONCLUSIONS:
S.IgA level seems to be an applicable index for evaluating EBV burden originated from
nasopharyngeal cancerous cells. Such index might help in diagnosing early and specifically the
carcinogenesis of NPC, moreover, might help in evaluating the progress of the disease.

A total of 63 terminal untreatable stage IV head and neck cancer patients were investigated for clinical
responses and presence of autoantibodies to various tissue antigens before and during S2- complex
immunotherapy.
METHODS:
S2 –complex is a new low molecular weight biological response modifier (BRM) with a potant
immunostimulating and anti tumor activities.
RESULTS:
Autoantibodies detected at pretreatment period were those directed towards the following antigens :
nuclear, thyroid microsomal, epithelial cells, gastric parietal cells, smooth muscles, peripheral
leukocytes, T-lymphocytes, B-lymphocytes, monocytes, thymus reticular epithelial cells and Hassall’s
corpuscles. Beside, autoantibodies with specificities to glomerular basement membrane and vascular
endothelial cells were present at low incidence. Short term use of S2- complex induced a transient
increase of the following autoantibodies: nuclear, thyroid microsomal, epithelial, parietal cells, smooth
muscle, thymus reticuloepithelial cells, Hassal’s corpuscles, thymocytes, peripheral blood leukocytes,
T, B-lymphocytes, monocytes, as well as kidney glomerular basement membrane and vasculr
endothelial cells.
DISCUSSION:
In the later follow up period i.e. 2-6 months most of these autoantibodies responses returned to normal
healthy control levels. Moreover, two exceptions were demonstrated which were the incidences of the
antiglomerular basement membrane and vascular endothelial antibodies which remianed higher than the
pretreatment frequencies. In addition, autoantibodies specific to mitochondria , thyroglobulin and red
blood cells were only occasionally seen in our head and neck cancer patients both before and during S2-
complex therapy

Aerobactin, Hemolysin and the resistance to some antibiotics axe important Features of
Uropathogenic E. coli (UPEC). The characteristics of patients from which we isolate the
UPEC have associate with these Features and their determinants location.
AIM:
We determined the phenotypic expression and gene location of Aerobactin and phenotypic
expression of Hemolysin among 60 UPEC isolates. We correlated the presence of Aerobactin system
with antibacterial agents resistance. The expression of Hemolysin and the characteristics of patients.
METHODS:
Two methods of plasmid curin, sodium dodecyl sulfate and elevated temperature plasmid curing, are
used then plasmid extraction and agarose gel electrophoresis are performed to determine the
location of Aerobactin determinants and the size of Aerobactin plasmids, as well as the location of
the determinants of some antibiotics resistance which were ampicillin (Am), Tetracycline (Tc),
gentamicin (GM), Chloramphenicol (C) and co- trimazole (Co).
RESULTS:
Aerobactin and hemolysin expression among UPEC isolates were 93.3% and 35% respectively. The
isolates of non compromised patients produce statistically higher rate of expressed hemolysin (90.5%
, p0.01). Plasmid- borne Aerobactin was absent in UPEC isolates of non compromised patients
(89.5%, p0.01). On the contrary compromised patient isolates express plasmid Aerobactin of 59.5%
(p0.02). We also found that Aerobactin determinants are located on a plasmid in compromised
patient isolates and associated with the absence of chromosomal Hemolysin production (82.9%,
p0.01). Yet, The chromosomal aerobactin is associated with hemolysin production (61.9%,
p0.02). Furthermore, UPEC isolates of compromised patients carry relatively large plasmid of
Aerobactin (85.7%. p0.05) and these large plasmids carry either chloramphenicol (83.3%.p0.02) or
gentamicin determinants (100%. P0.01) but not co- trimazole, tetracycline or ampicillin.
CONCLUSION:
The isolates of non compromised patients carry chromosomal Aerobactin and hemolysin. While the
isolates of compromised patients express plasmid Aerobactin and do not express chromosomal
hemolysin. Aeobactin plasmids are relatively large plasmids and carry either chloramphenicol or
gentamicin resistance determinants.

The Laryngeal Mask Airway Ahmed Abdulameer
THE IRAQI POSTGRADUATE MEDICAL, JOURNAL VOL.5, NO2.2006
The Laryngeal Mask Airway: technical guidelines and use in
special situations
Ahmed Abdulameer Salih
INTRODUCTION:
The laryngeal mask airway (LMA) is a novel device
that fills the gap in airway management between
tracheal intubation and use of the face mask. The
LMA is inserted blindly into the pharynx, forming a
low-pressure seal around the laryngeal inlet and
permitting gentle positive-pressure ventilation. It
allows the administration of inhaled anesthetics
through a minimally stimulating airway. It is
relatively simple to insert and may have a useful role
in management of the difficult or failed intubation (1)
The laryngeal mask airway(LMA) was developed
and first used by Dr.Archie Brain (2)(so some call it
Brain airway (3) ) in 1981. The LMA became
commercially available in the United Kingdom in
1988 (1).The LMA represents one of the most
important revolutions in the management of airway
during anesthesia.
The classical LMA (Figure 1a) consist of:
1. A transparent silicone tube of wide internal
diameter, the proximal end is a standard 15mm
connection (4).
2. An elliptical "spoon-shaped" mask with
inflatable rim "cuff"(5). The mask resembles a
small face mask and is inflated via a pilot
balloon with a self-sealing valve.
3. There are slits at the junctions between the
tube and the mask .These slits prevent the
epiglottis from obstructing the LMA (6).
There are different sizes of the LMA (Figure 1b).
Table 1 (below) shows the recommended LMA
sizes (according to the weight of the patient),
cuff inflation volume & the largest endotrachial
tube (ETT) that can pass through each LMA).
(a)
(b)
Figure 1. (a)The components of the Classical Laryngeal mask airway. (b) Different sizes of LMA.
Department of Surgery College of MedicineAl-
Summary:
Recent advances in airway management have changed the practice of anesthesia. Among these changes
has been the introduction and increasing use of the Laryngeal Mask Airway (LMA). The laryngeal mask
airway (LMA) is a novel device that fills the gap in airway management between tracheal intubation and
use of the face mask.
This study describes the LMA, different methods of LMA insertion, uses, advantages, problems,
complications and contraindications of LMA.
During eight years of LMA use in Al-Yarmook teaching hospital in Baghdad, the device was used for
wide spectrum of surgical procedures successfully. We report some special series of cases were LMAs
were used in providing a patent airway include LMA use with IPPV (intermittent positive pressure
ventilation), for patient with history of failed intubation, for children who require general anesthesia for
ultrasonic shock wave lithotripsy, the use of reinforce flexible LMA for nasal surgery and the use of total
intravenous anaesthesia with LMA. Also we describe two methods of blind endotracheal intubation
through LMA

The Laryngeal Mask Airway Ahmed Abdulameer
THE IRAQI POSTGRADUATE MEDICAL, JOURNAL VOL.5, NO2.2006
The Laryngeal Mask Airway: technical guidelines and use in
special situations
Ahmed Abdulameer Salih
INTRODUCTION:
The laryngeal mask airway (LMA) is a novel device
that fills the gap in airway management between
tracheal intubation and use of the face mask. The
LMA is inserted blindly into the pharynx, forming a
low-pressure seal around the laryngeal inlet and
permitting gentle positive-pressure ventilation. It
allows the administration of inhaled anesthetics
through a minimally stimulating airway. It is
relatively simple to insert and may have a useful role
in management of the difficult or failed intubation (1)
The laryngeal mask airway(LMA) was developed
and first used by Dr.Archie Brain (2)(so some call it
Brain airway (3) ) in 1981. The LMA became
commercially available in the United Kingdom in
1988 (1).The LMA represents one of the most
important revolutions in the management of airway
during anesthesia.
The classical LMA (Figure 1a) consist of:
1. A transparent silicone tube of wide internal
diameter, the proximal end is a standard 15mm
connection (4).
2. An elliptical "spoon-shaped" mask with
inflatable rim "cuff"(5). The mask resembles a
small face mask and is inflated via a pilot
balloon with a self-sealing valve.
3. There are slits at the junctions between the
tube and the mask .These slits prevent the
epiglottis from obstructing the LMA (6).
There are different sizes of the LMA (Figure 1b).
Table 1 (below) shows the recommended LMA
sizes (according to the weight of the patient),
cuff inflation volume & the largest endotrachial
tube (ETT) that can pass through each LMA).
(a)
(b)
Figure 1. (a)The components of the Classical Laryngeal mask airway. (b) Different sizes of LMA.
Department of Surgery College of MedicineAl-
Summary:
Recent advances in airway management have changed the practice of anesthesia. Among these changes
has been the introduction and increasing use of the Laryngeal Mask Airway (LMA). The laryngeal mask
airway (LMA) is a novel device that fills the gap in airway management between tracheal intubation and
use of the face mask.
This study describes the LMA, different methods of LMA insertion, uses, advantages, problems,
complications and contraindications of LMA.
During eight years of LMA use in Al-Yarmook teaching hospital in Baghdad, the device was used for
wide spectrum of surgical procedures successfully. We report some special series of cases were LMAs
were used in providing a patent airway include LMA use with IPPV (intermittent positive pressure
ventilation), for patient with history of failed intubation, for children who require general anesthesia for
ultrasonic shock wave lithotripsy, the use of reinforce flexible LMA for nasal surgery and the use of total
intravenous anaesthesia with LMA. Also we describe two methods of blind endotracheal intubation
through LMA

The Laryngeal Mask Airway Ahmed Abdulameer
THE IRAQI POSTGRADUATE MEDICAL, JOURNAL VOL.5, NO2.2006
The Laryngeal Mask Airway: technical guidelines and use in
special situations
Ahmed Abdulameer Salih
INTRODUCTION:
The laryngeal mask airway (LMA) is a novel device
that fills the gap in airway management between
tracheal intubation and use of the face mask. The
LMA is inserted blindly into the pharynx, forming a
low-pressure seal around the laryngeal inlet and
permitting gentle positive-pressure ventilation. It
allows the administration of inhaled anesthetics
through a minimally stimulating airway. It is
relatively simple to insert and may have a useful role
in management of the difficult or failed intubation (1)
The laryngeal mask airway(LMA) was developed
and first used by Dr.Archie Brain (2)(so some call it
Brain airway (3) ) in 1981. The LMA became
commercially available in the United Kingdom in
1988 (1).The LMA represents one of the most
important revolutions in the management of airway
during anesthesia.
The classical LMA (Figure 1a) consist of:
1. A transparent silicone tube of wide internal
diameter, the proximal end is a standard 15mm
connection (4).
2. An elliptical "spoon-shaped" mask with
inflatable rim "cuff"(5). The mask resembles a
small face mask and is inflated via a pilot
balloon with a self-sealing valve.
3. There are slits at the junctions between the
tube and the mask .These slits prevent the
epiglottis from obstructing the LMA (6).
There are different sizes of the LMA (Figure 1b).
Table 1 (below) shows the recommended LMA
sizes (according to the weight of the patient),
cuff inflation volume & the largest endotrachial
tube (ETT) that can pass through each LMA).
(a)
(b)
Figure 1. (a)The components of the Classical Laryngeal mask airway. (b) Different sizes of LMA.
Department of Surgery College of MedicineAl-
Summary:
Recent advances in airway management have changed the practice of anesthesia. Among these changes
has been the introduction and increasing use of the Laryngeal Mask Airway (LMA). The laryngeal mask
airway (LMA) is a novel device that fills the gap in airway management between tracheal intubation and
use of the face mask.
This study describes the LMA, different methods of LMA insertion, uses, advantages, problems,
complications and contraindications of LMA.
During eight years of LMA use in Al-Yarmook teaching hospital in Baghdad, the device was used for
wide spectrum of surgical procedures successfully. We report some special series of cases were LMAs
were used in providing a patent airway include LMA use with IPPV (intermittent positive pressure
ventilation), for patient with history of failed intubation, for children who require general anesthesia for
ultrasonic shock wave lithotripsy, the use of reinforce flexible LMA for nasal surgery and the use of total
intravenous anaesthesia with LMA. Also we describe two methods of blind endotracheal intubation
through LMA

Ebstein Anomaly is rare in adults; a combination of
this disease with cardiac myxoma has not been
reported previously.
METHODS:
Surgery was performed by removal of the myxoma
and replacement of the tricuspid valve and
correction of the abnormal atrialization of the right
ventricle.
RESULTS:
The patient had a smooth postoperative recovery
and improved dramatically after wards.
CONCLUSION:
We have dealt with this rare condition successfully
and the patient had good outcome