Al-Kindy College Medical Journal

Background: Dialysis is in common use to treat patients
with end stage renal failure .However longstanding dialysis
harboring some cellular changes in various body fluids.
This study was conducted in order to detect these changes
in urine.
Objective: The study was conducted to detect cellular
changes in urine of patients with longstanding dialysis.
Method: Fifty-three urine samples were examined
cytologically obtained from patients with longstanding
dialysis during 6 months period. Freshly voided midstream
urine samples were taken . Samples were centrifuged and 2
to 3 drops of sediments were smeared on 2 glass slides and
fixed in 95% ethyl alcohol then stained with Hand E stain
to be evaluated.
Results: Gross physical examination of all urine samples
were neither purulent nor hemorrhagic .Microscopically
there was increased exfoliation of urothelial cells except in
9 cases. No significant cytological atypia were seen in all
urine samples. Excessive exfoliation in the absence of
significant inflammation, hemorrhage and cytological
atypia compared with control group.
Conclusion: The study revealed that some cytological
changes do occur in the urothelial cells of patients with
longstanding dialysis. These changes need further attention
and study to disclose their causes.

Background: Displaced intracapsular fracture of the femoral neck remain a challenging issue despite the advancement in the ways of treatment .The purpose of this study is to assess the results of different methods of treatment in different age groups. Methods: This study was conducted over a period from (1998-2004) on 26 patients, with ages of 5 – 85 years with intracapsular fracture of the femoral neck due to different insults in Tikrit teaching hospital. Open reduction and internal fixation was done to those patients of<60 years of age, while uncemented Austin-Moore hemiarthroplasty was conducted in patients of >60 years old. Patients were followed for 6-12 months for any complication. Results: The main age group among the patients were those >60 years [13 (50%)]. The main cause of fracture was fall from standing position in 19 (73%), were treated by uncemented Austin-Moore prostheses. The main complications were hip and knee pain [8(30.7%) and5 (19.2%)] respectively. Non-union (11.5%) and avascular necrosis (11.5%) was the commonest complications in young patients, and were treated by internal fixation especially if the time of surgery was delayed over 24 hours. Conclusion: The reduction and internal fixation will continue to be used as the primary treatment of displaced intracapsular fracture in many younger patients because the benefits of preservation of the normal hip joint which should be done urgently within the first 24 hours. However, if this method of treatment is unsuccessful and requires revision, the risk of early complications is higher and hip function is poor. When hemiarthropla

Background: Environmental chemicals are thought to
adversely affect human reproductive function.
Objective : To estimate the concentration of cadmium(Cd)
, lead ( Pb ) and Zinc ( Zn ) in serum and seminal plasma
among infertile men .
Methods: A sample of 70 infertile men was investigated.
The relationship of trace elements concentration in serum and
seminal plasma was studied in relation to sperm density,
motility and sperm count.
Results: Except for Zinc the concentration of (Pb) and (Cd)
were generally higher in serum than in seminal plasma. The
mean concentration of (Zn) in seminal plasma was more than
25 times higher than in serum There were no statistical
significant differences observed in the serum and seminal
plasma levels of trace elements among the normospermic ,
oligospermic and azoospermic.
Conclusion: It seems that no significant relationship
between these trace elements and the clinical classification of
the infertile men was noted. Without considering
environmental conditions of life and work, way of nutrition
smoking and other possible factors, this study does not
present great value.

Background: For many decades, the ECG was the
workhorse of non-invasive cardiac test and today although
other techniques provide more details about the structural
anomalies in congenital heart diseases, ECG is likely to be
part of clinical evaluation of patients with such diseases
because it is inexpensive, easy to perform and in certain
situations may be both sensitive and specific.
Objective: this study carried out to identify the pattern of
ECG study in patients with TOF.
Methods: this is a retrospective study of 200 patients
with TOF, referred to Ibn Al-Bitar cardiac center from
April 1993 to May 1999. The diagnosis of TOF established
by echocrdiographic, catheterization and angiographic
study. For each patient, the ECG tracing had been analyzed
for rhythm, p-wave, P-R interval, QRS axis, duration and
T-wave in V1 and any chamber enlargement.
Results: The ECG analysis revealed that all patients had
sinus rhythm, normal P-R interval and normal p-wave
duration and amplitude, and normal QRS duration. All
studied patients had one criteria of RVH and 95% of them
had two or more of such criteria.
Conclusion: we found that in the absence of RVH
criteria, the diagnosis of TOF is unlikely and the present of
northwest axis should indicate canal type VSD

Background:Oriental sore occurs mostly in the
mediteranian region , North Africa ,and the Middle East .
Rodents are the main reservoir for the parasite . The wet
type caused by L. major is rural and the dry type caused by
L. tropica is urban and humans are presumably the only
reservoir. Sand fly vectors are involved in all forms.
Objectives: This study aimed to show the most
important bacterial infections concomitant with cutaneous
leishmaniasis .
Methods; The study was performed on 75 patients (ages
1-50 years ) from both sexes were attending Skin Diseases
Department of Ramadi General Hospital during the period
extended from January to June 2000. These patients were
clinically diagnosed as patients with cutaneous
leishmaniasis. Skin specimens were taken for
bacteriological and parasitological investigations .The same
thing was done for specimens from 25 intact individuals
resembling the test group as negative controls.
Results: Children showed more lesions with Positive
cutaneous leishmaniasis, adult females, showed more l
lesions than adult males. Children showed more bacterial
isolates than adults, from both positive and negative l
lesions. Staphylococcal and Streptococcal isolates took the
first rank of isolation in all age groups and both sexes. E.
coli and fecal Streptococci were isolated from children
only.
Conclusion: Bacterial invasion for the skin lesion with
cutaneous leishmaniasis complicates the lesion and leads to
misdiagnosis, in addition to the delay of healing of the
lesion via bacterial end-products. There is a need for
accurate diagnostic techniques like polymerase chain
reaction (PCR) for both bacterial and parasitic agents,
suitable effective antimicrobial therapy, in addition to the
antileishmanial agents. Good sanitation of the lesion and
community education to prevent infections

Back ground : Fever is a common medical problem in
children. parents have been shown unrealistic fears of
harmful effects of fever in their children. Resulting in
inappropriate management of fever in their children.
Objective: the objective of this study was to survey
parents about their knowledge andattitude concerning fever
in their children.
Methods : The study involved random selection of
parents who brought their febrile children to emergency
department or out-patient clinics of five teaching and non
teaching hospitals in Baghdad from first of October to end
of December 2002.
Parents of 400 febrile children were interviewed using a
standard questionnaire to obtain sociodemographic
information and current knowledge of fever.
Results: Approximately 69% of the respondents were
female, 68% their age was in the range of 21-35 years.
Seventy seven percent of parents had two or more children.
More than 70% of parents demonstrated a poor
understanding of definition of fever , maximum
temperature of untreated fever and threshold temperature
requiring antipyretics . Twenty sevev percent of parents
considered temperature less than 38.0 c
o
to be fever,
another 27% did not know, the definition of fever, 61% felt
that temperature of less than 40,0 c
o
could be dangerous to
a child, and 27% could not define high fever. Another 28%
believed that if left untreated, temperature could rise to
42.0 c
o
or higher, but 39% could not provide an answer,
and about 60% did not know the minimum temperature for
administering antipyretics. And 60% did not know the
minimum temperature for bathing , or sponging.
Approximately 93% of parents demonstrated fear of
consequent body damage from fever , including convulsion
,brain damage ,coma, blindness and even death.
Conclusion: parental misconception about fever reflects
the lack of active health education. Health professionals
have apparently not done enough to educate parents on this
common medical problem and it,
s consequences

Background: Arthrogryposis Multiplex congenita is a
rare disorder, characterized by multiple joint deformities
i.e. multiple congenital contractures, with shapelessly
cylindrical limbs and absent skin creases.
Club foot can be the only obvious deformity of this
widespread disorder.
Objective: To assess the most frequent recurrent
deformity after extensive soft-tissue release operations for
arthrogrypotic club foot and its appropriate treatment
regarding combined tendon transfer and bony operations.
Methods: A retrospective study of 14 patients with
arthrogrypotic club foot (28 feet), had been operated on by
multiple soft tissue and bony operations and followed in a
period between January (1993) till February (1999).
Both clinical assessment including goniometer use to
measure the recurrent deformity, and radiological
assessment, was used in this study.
Results: In this series, 4 patients (7 feet) had recurrent
deformity, 3 patients
(5 feet) out of these 4 had recurrent forefoot adduction, 2
of them had bilateral affection. The 4th patient had
bilateral recurrent varus heel.
Conclusion: The main problem in arthrogrypotic club
foot is the liability for recurrence. The most frequent
recurrent deformity was forefoot adduction. Combined
tendon transfer and bony operations can correct the
deformity once performed at the same cession forefoot
adduction. All required 2nd operation, in the 1st 3 patient
combined Evan’s (calcaneocuboid wedge-excision) and
tibialis anterior transfer operations were performed.
Talectomy was performed on one foot in the 4th patient,
combined with capsulectomy of the calcaneocuboid joint,
while triple arthrodesis don on the other foot

Objective: To evaluate male patients complaining of
urethritis clinically according to the isolated organisms.
Method: A total of 100 male patients attending to of
Dermatological and Venereal private clinics for the period
April 2003 to November 2003 were included in the study.
Urethral swab was obtained from each male for culture and
direct immunofluorescence examination was done.
Demographic data was obtained, also.
Results: N. gonorrhoea was the predominate cause of
infection in 22%. A peak of infection was reported in the
second decade of age. Highest rate reported among single
males. A significant association was noticed between
profuse discharge and infection with gonorrhoea.
Conclusion: This study demonstrated that peak of
infection in the second decade of age and among singles. A
broad range of causative agents was reported.

Background: occult blood loss must be considered as a
possible cause in every case of iron deficiency anemia.
Objective: to evaluate upper gastrointestinal endoscopy
in finding a potential cause for iron deficiency anemia
among children in Al-Anbar governorate.
Methods: Twenty five children aged 2-14 years, referred
to the gastroenterology unit in Al-Ramadi General Hospital
for upper gastrointestinal endoscopy had iron deficiency
anemia. Fiberoptic endoscopy was used under general
anesthesia and endoscopic tissue biopsies were taken from
22 patients for histopathological examination.
Results: The main presenting signs and symptoms were
pallor, abdominal pain, and stunting. The upper
gastrointestinal endoscopy showed thinning of duodenal
folds & serrated mucosa in 8 (32%), duodenal ulcer in 3
(12%), esophageal varices in 1 (4%), nodular gastritis in 1
(4%), and reflux esophagitis in1 (4%), with a yield rate of
56%.
While tissue biopsies revealed histopathological findings
suggestive of celiac disease in 12 (48%), Giardia lamblia in
2 (8%), Helicobacter pylori gastritis in 1 (4%), and
esophagitis in 1 (4%). There was a significant association
between the endoscopic finding of thinning of duodenal
folds and serrated mucosa and the histopathological
finding suggestive of celiac disease, P<0.05.
Conclusion: Iron deficiency anemia in children 2-14
years of age warrants upper gastrointestinal endoscopy to
find potentially treatable causes for the iron deficiency
anemia

Background: Transplantation has revolutionized
treatment of end- stage renal disease (ESRD) by proving
more cost effective than hemodialysis, with a lower
morbidity and improved quality of life.
Objective: To evaluate the development of these
complications in the first month postoperatively and
correlate their development to the type of donation
whether related or unrelated.
Methods: Fifty (50) patients aged (15-62) years, with a
mean age (34.46 ± 12.4 SD) years with (ESRD), who
underwent renal transplantation from September 2000 to
October 2002, were followed-up for one month
postoperatively clinically and by assessment of renal
function tests, sonographic and Doppler examinations.
Ureteral obstruction was considered in those patients who
had allograft dysfunction, ultrasonic evidence of
peritransplant collection, moderate-severe dilatation of
upper urinary tract of transplanted kidney and
postoperative ipsilateral or bilateral leg edema. Ureteral
leakage was considered in those patients who had
persistent drainage of urine with or without allograft
dysfunction. Two patients were excluded from the followup due to death in the first 24-hour postoperatively.
Results: Six (6) patients (12.5% of cases) developed
ureteral obstruction due to peri-ureteral fluid collection. In
five patients the collection decreased and upper urinary
tract dilatation improved gradually, as shown by
ultrasound, on watchful waiting. One patient had surgical
evacuation of a large hematoma. Four (4) patients (8.3%
of cases) developed ureteral leakage. The leakage stopped
in one patient after keeping the urethral catheter for a
longer period. Three patients had surgical exploration due
to persistent urinary leakage. Redo implantation of
allograft ureter was done in two cases.
Development of ureteral complications was compared
with the type of donation (related or unrelated). The
comparison was not statistically significant.
Conclusions: The development of ureteral
complications in not related to the type of donation.
Extravesical ureteral anastamosis with the use of a stent is
less likely to be associated with postoperative ureteral
complications.

Background: Lung cancer is responsible for the most
cancer deaths in both men and women throughout the
world. Deaths from lung cancer (160,440 in 2004,
according to the National Cancer Institute) exceed the
number of deaths from four other major cancers combined
(breast, colon, pancreatic and prostate).
Objective: To assess the behavior and the approaches of
lung cancer in a sample of Iraqi patients.
Methods: This descriptive retrospective study was
performed using the records of 390 patients proved to have
lung cancer that had attending the Thoracic Surgery
Department of Surgical Specialties Hospital-Medical City
\Baghdad for the period from January, 1st
, 2001 to
December, 31st
,2002.
Results: The results of this study revealed that 71.8% of
the patients were male, with a mean age of 63 years. The
majority of the patients (90.2%) were smokers, the number
of cases increases with the increase in the duration of
smoking or the amount of daily cigarette smoking.
Radiotherapy is the primary management of 75.9% and the
surgical choice was in 24.1% of the patients, but the
tumors were removed only in 42.5% of operable patients.
Conclusions: Lung cancer is an important and serious
public health problem with an increasing in incidence and
prevalence in Iraq; cough is the most common clinical
finding, found in 98.5% of patients, followed by
haemoptysis (64.1%); cigarette smoking is responsible for
the at least 90% of its etiology. Sequamous cell carcinoma
is the most common type of primary lung cancer in Iraq
(42.6%) with prominence in male gender; adenocarcinoma
is the second common type with equal distribution in male
and female

Background: Cytology is one of the important diagnostic tests done on effusion fluid. It can detect malignant cells in up to 60% of malignant cases. The most important benign cell present in these effusions is the mesothelial cell. Mesothelial atypia can be striking andmay simulate metastatic carcinoma. Many clinical conditions may produce such a reactive atypical cells as in anemia,SLE, liver cirrhosis and many other conditions. Recently many studies showed the value of computerized image analysis in differentiating atypical cells from malignant adenocarcinoma cells in effusion smears. Other studies support the reliability of the quantitative analysisand morphometric features and proved that they are objective prognostic indices. Methods: Sixty three cases of pleural and peritoneal smears, previously reported as benign (19) cases, malignant (21) cases or atypical (23) cases, were retrieved from the files. In each of these smears; nuclear area, perimeter, and roundness coefficient of 80-100 cell were determined at x400 magnification by the use of image analysis system. Statistical analysis was performed using analysis of variance and Tukey's HSD test. Results: The mean values of nuclear roundness, nuclear perimeter and nuclear area vary between the three groups (benign, atypical and malignant cells) by using analysis of variance (p > 0.01). The value of nuclear roundness, perimeter and area did not differ significantly between benign and atypical cells (Tukey’s test: p<0.01). On the other hand, the value of nuclear roundness, perimeter and area showed a significant difference between malignant and atypical cells(Tukey's test: p> 0.01). Conclusion: In conclusion, our data suggest that cytomorphometry performed on effusion smear cells may provide important information for the differentiation of atypical cells from malignant cells, in which the values of atypical cells are closer to those of benign cells during the examination of pleural and peritoneal smears by the use of image analysis system

Objectives: To choose the best mode of delivery
for term, frank or complete, breech presentation
through studying the perinatal outcome of each mode of
delivery decided when managing a group of pregnant
ladies presented with breech delivery in our centre.
Methods: One hundred and fifty pregnant ladies
presented at term with singleton, frank or complete,
breech presentation for delivery in our centre during the
period from May 2004 toAugust 2005.
Mode of delivery, parity, gestational age, maternal age,
maternal medical illness, and birth weight where the
variables that have been tested in each delivery
included in the study to verify their relationship to
perinatal outcome.
Results: No significant relationship is found
between the occurrence of adverse perinatal outcome
and the variables. However, mode of delivery was the
major determinant of the perinatal outcome.
of the 150 pregnant ladies, 46 were delivered vaginally,
32 had elective caesarean section, and the remaining 54
pregnant, had undergone an emergency caesarean section
because they were presented with labour. Thirteen (8.6
%) babies were adversely affected by the process of
delivery, 9 (5%) of them were delivered by vaginal route,
3 (2 %) delivered by emergency caesarean section and one
(0.6%) by elective caesarean section.
Conclusion: Elective caesarean section is regarded
the safest way of delivery for those with term, frank or
complete, breech presentation.

Background: Acute cholecystitis is common surgical
problem, which was treated previously by conservative
treatment .Later early open has been introduced as an
alternative to interval for treatment of acute cholecystitis.
Early open was found to be a safe, successful with
comparable postoperative complication rate. With the
advent of laparoscopy laparoscopic have been used for
chronic cholecystitis and became the first line of
treatment. New reports have shown that laparoscopic can
be used as an alternative to open for surgical treatment of
acute cholecystitis.
Objectives: to compare the success, safety of early
laparoscopic versus early open as a primary treatment of
acute cholecystitis.
Methods: out of 68 patients were treated for clinical
acute cholecystitis between January 2002 and February
2004 in the department of surgery, at Al – Kindy teaching
hospital. A total of 62 patients underwent early for acute
cholecystitis as soon as possible after diagnosis. The
preferred preoperative imaging technique was ultrasound.
30 (48.3%) of the operations were attempted
laparoscopically, whereas the remaining 32 patients
(51.7%) underwent initial open .
Results: The mean operative time for the open cases
was 75 minutes versus 60 minutes for the laparoscopic
group. There was no perioperative mortality in either
group. The incidence of conversion to open was 10% (3
patients). Surgical complications related to laparoscopic
and open occurred in 2 (6.6%) and 3 (9.3%) cases,
respectively. There was no difference between the open
and laparoscopic groups in regard to the major
postoperative complications.
Conclusion: The current study shows that early
(whether performed by open or laparoscopically) is a
safe and effective treatment for acute cholecystitis. Low
conversion rates can be maintained with strict guidelines
for appropriate patient selection, adequate experience,
and proper laparoscopic technique.

Background: Pyogenic discitis most frequently occurs
after home delivery, hemorridectomy, and dilatation and
curettage. Discitis is generally due to blood borne bacterial
invasion of the disc from adjacent end-plate via
communicating vessels. Infective discitis remains an
uncommon, but potentially serious cause for back pain.
Delayed diagnosis can occur and a high index of suspicion
may occur.
Methods: The study included 30 patients suffering from
localized low back pain with limitation of movement.
Diagnosis was made by history, physical examination and
investigation mainly E.S.R and MRI.
Results: 50.3% of patient with discitis had a history of
vaginal delivery, 15% had a history of hemorridectomy and
10% had a history of dilatation and curettage and cesarean
section surgery. All patients had elevated E.S.R, Positive
C-reactive protein and positive MRI finding.
Conclusion, We must think of Pyogenic discitis in any
patient with sever backache, fever, local tenderness, and
high ESR