Mustansiriya Medical Journal

Background: Cryptorchidism is the absence of one or both testes in the scrotum and is generally synonymous with undescended testis, in 20% of these cases undescended testis is clinically nonpalpable, we employed diffusion weighted imaging (DWI), as well as conventional magnetic resonance imaging (MRI) to increase sensitivity of diagnosis of the non-palpable testis. Objective: To evaluate role of diffusion weighted MRI in the detection of non-palpable undescended testes. Patients and Methods: twenty boys with unilateral undescended testis underwent preoperative abdominal and pelvic MRI to identify the location of the testis. MRI included free-breathing Diffusion-weighted imaging (DWI) with b values of 300 and 600 s/mm2, T1 and T2-weighted sequence, and T2-weighted fat-suppressed sequence, after surgical operation, two observer groups reviewed the preoperative images, starting with DW images alone, then the conventional MR images alone and after that the conventional-MR and the DW images together. Sensitivity, in the identification of nonpalpable undescended testis was calculated for DWI, conventional MRI, and the combination of DWI and conventional MRI. Results: The combination of DWI and conventional MRI was the most sensitive for detection of non-palpable undescended testis. The two observers detected 12 testes with this technique. Sensitivity 92.3 % for two observers, and. With DWI alone, observer 1 located 11 testes, and observer 2, located 12 testes (sensitivity 84.6% and 92.3%) respectively, by using conventional MRI alone, both observers located 10 testes (sensitivity, 76.9%). The sensitivity for locating testis was superior with the combination of DWI and conventional MRI for both observers. Conclusion: Use of DWI with a high b value gives information that complements conventional MRI findings, improving identification and location of non-palpable undescended testes. We recommend the use of DWI in addition to conventional MRI to increase the preoperative sensitivity of identifying and locating non-palpable testes

Background: Hearing loss has a detrimental effect on the patient`s communication, vocational and social life, and in children, it affect speech development and school performance. There are many types of hearing aids to help the patients to overcome the difficulty of hearing and communication and some of them, like the in the ear hearing aids, are preferred cosmetically. Binaural hearing aid fitting was proved superior to monaural fitting in terms of speech discrimination in noise and localization of sound. Objectives: to compare the types of hearing aids dispensed in private and governmental sectors. Methods: Hearing aid users from private and governmental sectors were analyzed retrospectively during the interval from Jan to Dec 2012, and it included 110 and 166 hearing aid users respectively. Results: Privately, 59.1% of hearing impaired patients used in the ear type, 40.9% used behind the ear type and the rest of patients, 11.8%, used binaural hearing aids; whereas in the governmental sector, the users of these types accounted to 3.1%, 96.9% and 0% respectively. About two-thirds or more of the ears aided with hearing aids were of moderate degree and sensori-neural type in both sectors. Conclusions: It is necessary to change the policy of hearing aid fitting in the governmental sector with paying more attention to binaural hearing aid fitting, and hearing aid prescription is geared to the need and desire of hearing aid users.

Background: acute poisoning is an important cause of morbidity and mortality in children all over the world. Objectives: to find out the types of acute accidental poisoning (AAP) in children in Baghdad and various host and environmental factors responsible for. Method: one hundred and seventy poisoning cases and hundred controls were enrolled in a case control study done in central pediatrics teaching hospital for the period from 1st of Jan. 1998 to 30th of April 1998. Results: kerosene poisoning was the commonest type (56.4%) followed by drugs (23.5%) then organophosphorus insecticides (11.8%), household products (3.5%). The highest frequency was noticed at 8.00 am-12.00 noon followed by 12.00 noon – 4.00 pm. It has been found that there is no significant relationship between poisoning and sex of child, mother educational level but the followings found to be significant risk factors: age of 1-3 years followed by 3-5 years, urban residence, peak time of poisoning was during mid-morning hours and early afternoon, also order of the child (5th) besides family size (family of 4-7 members), mother's age of above 35 years, not working mother (housewife). Also it showed a relation with recurrence of poisoning in the same child (7.1%) or other sibling in the same family (16.5%) , being at home (86,5%) and use inappropriate method of storing and placing poisonous materials. Conclusion & recommendations: significant risk factors regarding younger age, larger family size, early day time occurrence and recurrence of accidents in the same family, in addition to improper storage places necessitate the need for earlier poison prevention education programs as an integral part of well child visits even before child is mobile.

Background: Lumboperitoneal shunting (LPS) is an operation in which CSF is diverted from lumbar subarachnoid space into the peritoneal cavity by devices designed for this purpose using a simplified surgical technique. Objectives: This study aims to evaluate retrospectively the indications, operative technique and complications of this technique. Methods: Over a six-year period from September 2004 to September 2010, a retrospective evaluation of 21 patients selected for LPS in Baghdad hospitals was carried out. Fifteen patients had Idiopathic intracranial hypertension, four patients had persistent rhinorrhea & two patients had communicating hydrocephalus. Results: There was an improvement of 93.7% of cases suffering from headache, 76.9% of cases suffering from visual defects. There was improvement of 100% of cases suffering from rhinorrhea, dizziness & papillodema. The postoperative complications were minor & minimal in 14.1% of cases. Conclusion: LPS provides an attractive and technically simple solution for a wide range of neurological disorders. It is purely extracranial procedure & it carries no significant morbidity & without any mortality

Background: The most common definition of small for gestational age newborns refers to a birth weight below the 10th percentile for gestational age. Intrauterine growth retardation may be caused by maternal, placental, or fetal factors, however no underlying etiology can be identified in at least 40% of those infants. Objectives: To assess some of the risk factors of small for gestational age in full term neonates. Patients and methods: A case control study extended over seven months from 1st June 2012 to end of December 2012, which was performed in the delivery rooms and neonatal special care baby unit in AL-Yarmouk Teaching Hospital in Baghdad. Data was collected by direct interview of the mothers, including different variables of newborns gestational age, weight, sex, presence of congenital anomalies and multiple gestation. Mother's age, residency, parity, employment, smoking, family history of small for gestational age, history of still birth, antepartum hemorrhage, antenatal care visit, presence of urinary tract infection, chronic hypertension or gestational hypertension, diabetes mellitus and anemia were evaluated. In this study, 100 small for gestational age newborns and 100 appropriate for gestational age newborns were evaluated within the first day of life. Results: There was significant relationship between small for gestational age and mother's age ≤16year (p=0.004), employed mothers (p=0.039) and primipara (p=0.002). Deliveries of small for gestational age had a significant relationship with irregular antenatal care visit (p=0.0001), and with family history of small for gestational age (P=0.0001). Newborns of small for gestational age had a significant relationship with maternal history of antepartum hemorrhage (p=0.010), still birth (p=0.017), maternal history of urinary tract infection (P=0.036), maternal history of hypertension (p=0.003) and history of maternal anemia (p<0.001). Conclusions: There was a significant relationship between small for gestational age births and: maternal age, employment, antenatal care visit, parity, family history of small for gestational age, antepartum hemorrhage, still birth, maternal history of hypertension, urinary tract infection and anemia, but no significant relationship with the newborn's sex, residency and diabetes mellitus of mothers

Background: Despite the improvement in health care in general and antiseptic techniques in particular, cases of gluteal abscess following intra-muscular injections are still encountered. Although this condition is not considered a serious illness, still it causes complications and exerts a pressure on health resources. Objectives: To determine the factors responsible for the development of gluteal abscesses and to suggest measures to avoid this problem and to study the methods used in management. Methods: This is a prospective analytic study in which all patients admitted to the surgical ward with gluteal abscess over a six months period were included. Detailed demographic, clinical and investigative data were recorded. Predisposing factors and co-morbid conditions were documented, also, the persons who did the injection, the types of drugs used and other factors related to the process of injection were studied. The contribution of the human, technical and pharmacological elements were analysed. The methods used in management, early post-operative complications and the final outcome were recorded. Results: Forty-two patients were included in the study; of those, 30 were females (75%) and the mean age was 35 years. Eighteen were diabetic (42.8%) and 16 (38.04%) were over-weight. Thirty-eight patients (90.47%) had history of preceding intra-muscular injections. Most of the drugs used were antibiotics, mainly Cefotaxime used in 14 patients (33.33%). There was also 8 instances related to Diclofenac injection (19.04%) and 4 related to iron preparation (9.5%). There were 8 instances of mixed injections using more than one drug (19.04%). Twenty-eight episodes were related to under-trained personnel (66.67%); 20 female nurses (47.62%) and 8 male nurses (19%). Forty patients presented mainly as local pain(97%) and 36 patient as visible swelling(90%). The main method of diagnosis was clinical. All patients were treated surgically mostly using general anaesthesia (95%) and frank pus obtained in 34 patients(80.95%). The most common organisms obtained on culture were coagulase-positive staph.aureus and proteus. Conclusions: Gluteal abscess disease is still common despite advances in anti-septic techniques. Most of the cases are due to the lack of experience and improper training of para-medical personnel. This condition is seen more with certain types of drugs and in immune-compromised patients like diabetics.

Background: Maternal diabetes is an important risk factor for development of fetal macrosomia. Studies showed that elevated lipid profile levels in third trimester of the diabetic pregnant women may predict the macrosomia of the newborn babies. Objective: To assess the relationship of elevated lipid profile levels in third trimester with the occurrence of macrosomia in diabetic pregnant women. Study design: A case control study. Setting: Carried out at AL- Yarmouk Teaching Hospital/ Department of Obstetrics and Gynecology for one year from March 2011 to March 2012. Patients and Methods: A hundred pregnant women were enrolled in this study. Fifty women with diabetes mellitus (twenty six women with gestational diabetes mellitus, sixteen women had type 1diabetes mellitus, and eight women had type 2diabetes mellitus) and fifty healthy pregnant women taken as a control. Both groups were in the third trimester. The two groups were comparable for maternal age, gestational age, parity and body mass index. Blood samples were taken for measurement of serum lipid and sugar profile from both groups and correlated with the occurrence of macrosomia. Results: There were a significant and direct correlation between macrosomia and total cholesterol, triglyceride, low density lipoprotein and very low density lipoprotein cholesterols in diabetic groups (Gestational diabetes , type 1& type 2 DM ) in comparison to the control group (p=0.0275, 0.0001, 0.031, 0.0001). There was a significant inverse correlation between macrosomia and high density lipoprotein cholesterol in diabetic group in comparison to the control group (p=0.043). Conclusion: Macrosomia in newborns of diabetic pregnant women is associated significantly with maternal dyslipidemia during the third trimester of pregnancy.

Background and aim: Acute lymphoblastic leukemia (ALL) is a lymphoidmalignancy, which arises from bone marrow,appearing in marrow, blood circulation and otherorgans. Treatment outcome have significantly improved since the adaptation of intensification and risk adapted therapy-based on identified prognostic markers. Treatment programs in adult ALL have evolved from the successful strategies employed in pediatric ALL and incorporate multiple active agents into complex regimens. The goal of these doses intensive regimens is rapid cytoreduction with restoration of normal hematopoiesis, The aim of the study was to assess the efficacy of a modified German multicenter study group for Acute Lymphoblastic leukemia (GMALL) protocol in adult acute lymphoblastic leukemia (ALL( in respect to disease free survival (DFS) and overall survival(OS) and to determine the prognostic factors affecting this outcome. Patients and method: A prospective study conducted in the hematology unit in Baghdad Teaching Hospital on 50 patients with newly diagnosed (ALL) between January 2006 to January 2008.A written informed consent were obtained from all patients. All patients were undergone full clinical examination with full laboratory investigations. The diagnosis based on morphology and cytochemical stains (periodic acid-Schiff, Sudan Black) of bone marrow examination. In Modified GMALL, induction phase consist of 2 phases, phase 1 induction was given over 5 weeks with weekly vincristine (VCR), Doxorubicin(DOX), and continuous oral prednisolone(RDN), Phase II induction consisted of 3 doses of weekly cyclophosphamide(CYCLO) alternating with 3 doses of weekly cytosine arabinoside (ARA-C) combined with CNS directed therapy using intrathecal Methotrexate (MTX) with daily 6-mercaptopurine(6-MP) followed by cranial irradiation. Consolidation consisted of weekly VCR and two courses of 5 days Ara-C and Etoposide (ETOP) with dexamethasone (DEXA) over a period of 4 weeks and maintenance therapy of daily 6-MP tablets and weekly MTX tablets. Results: The study included 50 patients with median age of (28.5 years), ranged from 16-71 years. Thirty-one patients (62%) were males, while 19 patients (38%) were females. All patients received modified GMALL protocol; forty-two patients (84%) achieved complete remission (CR). The DFS and median OS were 8.5 months, 10 months respectively. The median OS at 1 year was 54%. Deaths occurred in 19 patients (38%). Infection was the main cause of death.In univariate study analysis, age less than 30 years, absence of hepatomegaly and lymphadenopathy, and peripheral blast percent less than 50% were associated with better OS while presence of lymphadenopathy was considered poor prognostic factors and associated with low CR rate, short DFS, and OS. Conclusion: The modified GMALL protocol produced good induction remission rate but with lower survival rate in comparison to other intensive adult protocols. This study also showed that there are certain bad prognostic factors such as age more than 30 years, hepatomegaly and lymphadenopathy which adversely affect the outcome

Objective: to verify whether fetal colon caliber correlate with gestational age from 34 to 40 weeks of gestation and to develop equation and chart which can be used for pregnancy dating by measuring colon caliber. Methods: a total of 220 healthy pregnant women whose age range from 18- 35 years were collected. They were distributed as 30 patients for each of the following gestational ages 34, 35, 36,37,38,39 weeks and 40 patients for 40 weeks of gestation. Their head circumference, abdominal circumference, bi-parietal diameter and femoral lengths were assessed by ultrasound. In addition colon caliber was assessed in the transverse colon. Result: there was a highly significant correlation between colon caliber and gestational age in days. In addition a highly significant correlation between colon caliber and bi-parietal diameter, femoral length, head circumference and abdominal circumference were found with P values < 0.0001. A formula was developed to calculate gestational age directly from the fetal colon caliber alone. The equation accuracy was checked by Kappa- Cohen coefficient and found to be 0.71 indicating good predicative ability of this formula. Conclusions: despite a new easy to use formula and associated easy to use chart was developed yet we call for extreme caution in its use as we don’t know its significance in real life obstetrical world. Further studies are required to confirm its reliability and safety.

Background: Breast cancer accounts for 26% of all new cases of cancer among women and is the leading cause of death in those aged between 20-59 years, Estrogen and Progesterone receptors play an important role in the development and prognosis of breast cancer, their measurement by immunohistochemical assay is vital in the hormonal management of breast cancer. Aims: To estimate the prevalence of Estrogen and Progesterone receptors positivity in female breast cancer cells in Al-Yarmouk Teaching Hospital. Patients & methods: A prospective study for breast cancer cases in females in Al- Yarmouk Teaching Hospital for the period from 1st of July 2009 to 31st of December 2010 , By using immunohistochemical study in the Histopathological department of Al-Yarmouk Teaching Hospital , the results were correlated with age of the patients, tumor size, grade and tumor histopathological type. Results: Total No. of patients studied were fifty. During the study, the age frequency was higher in the postmenopausal group (54%); the Estrogen Receptor (ER) +ve highest content (55.55%) was observed in that group, the Progesteron (PR) +ve highest level (52.17%) was observed in a premenopausal group (46%),Receptor positivity in Tumor size of the favorable type means equal to or less than 5 cm present in (92%) of the cases in which ER+ve level (58.69%) is the highest in that type, while the PR+ve level was (50%) in the unfavorable type means size above 5 cm which represent (8%) of the total cases. Regarding the relation with Tumor Grade the frequency of Receptors positivity in grade II (56%) more than grade I (24%) then grade III (20%), The highest ER+ve level (75%) was observed in grade I while PR+ve highest level (42.85%) in grade II, In studying the histopathological types the most prevalent type is infiltrative duct carcinoma (I.D.C) (62%) which have the highest ER+ve level (64.51%) while PR+ve level (42.10%) was high in infiltrative lobular carcinoma (I.L.C) type. Conclusions: Breast cancer in this hospital has the same pattern of age incidence worldwide and histopathological type but of the more favorable type with lower Grade of malignancy. This reflects a changing trend towards less aggressive pattern. The variability of ER & PR positive contents in this study needs further studies to compare our results with because the Iraqi cancer registry lacks data on hormonal receptor contents of breast cancer cases

Hydatid cysts of the liver and/or lung are commonly seen in surgical practice in endemic areas like Iraq. Primary or secondary skeletal muscle hydatidosis is rarely reported, even in endemic areas. This is a case report of a 51 year-old, otherwise healthy, man with a firm non-fluctuant cystic swelling in the right thigh that was painless and growing slowly over a period of six months. While ultrasound and magnetic resonance imaging suggested a multilocular cystic lesion, other investigations failed to confirm the diagnosis of muscular hydatid cysts, especially in the absence of a primary cyst in the more common organs. The lesion was initially considered a soft tissue tumor but intraoperative exploration revealed a hydatid cyst with daughter cysts, that was excised and the patient was treated with Albendazole for 1 month postoperatively. The patient developed a seroma that disappeared spontaneously. There was no recurrence for up to 4 months of follow-up. This report illustrates that echinococcal disease should be considered in the differential diagnosis of a cystic mass in any anatomic location, especially when it occurs in endemic areas.

Objective: To assess the relationship between serum leptin level and acute myocardial infarction in patients who received thrombolytic therapy. Methods: Fifty patients with acute myocardial infarction (mean age:58.16±11.73 years)at first 12 hours of admission and thirty four normal control group (mean age: 53.98±15.46 years) matched for age ,sex and other risk factors were enrolled in this study, serum level of cardiac troponin I was measured in patients and control group( mainly for diagnostic purpose),two readings were obtained for the patients( one at admission and 6-9 hours later).The patients were followed up clinically during entire hospitalization period to assess patients response to thrombolytic therapy as well as for the development of any complication, Serum level of leptin also measured in the first 12hour in both groups. Results: The study showed that serum leptin level in patients with acute myocardial infarction(mean 10.03ng /ml) was significantly higher than that of control group (mean 6.97ng/ml), p value <0.0001. Conclusion: The present study showed that higher serum level of leptin was associated with occurrence of myocardial infarction as etiological factor or sequel.