Journal of the Faculty of Medicine Baghdad

Summary
Back ground: Colorectal cancer is one of the leading causes of death allover the world especially in the developed countries. Each year approximately one million veterans aged 50 and older will develop colorectal cancer over the remainder of their lives and nearly 433,000 will die from it. Because most cancers are diagnosed after local or regional spread, nearly half of all patients diagnosed with colorectal cancer will die lWarly detection and management definitely decrease mortality.
Patient and methods: This is a prospective study on fifty patients with colorectal cancer admitted at the first surgical unit in Baghdad teaching hospital since March 2000 till March 2003 The data collected from those fifty patients were analyzed according to the history, physical examination and investigations with special consideration to the mode of presentation , type of investigations and the cause of delay in diagnosis,
Results: The most valuable investigation was colonoscopy and biopsy Abdominal ultrasound was very helpful tool in diagnosis of right sided colonic tumors.Also barium enema has a good role in diagnosis of patients with colorectal cancer.
Conclusion: We concluded that most delay in diagnosis of patients with colorectal cancer was patient related (fifty percent of cases ).A significant delay was related to the patients and general practitioner In a few cases the delay was related to the patients and consultant surgeon and a single case related to the general practitioner only.

Background :The retroperitoneal tumors is usually confined to lesions arising from tissues (muscles, fat, lymph nodes, nerves, and, developmental remnant) of this compartment but excluding origin from the retroperitoneal organs (panaceas, kidney, ureters and adrenals). The aim of the study is to focus a light on the types of retroperitoneal tumors, ways of the investigations and the presentations.
Methods :A prospective review study of 25 patients with retroperitoneal tumors has been collected in the Medical City Teaching Hospitals During the period between Jan 2001 to Mar 2004. The data included age, gender, risks factors, clinical presentations, diagnostic modalities and results of histopathology.
Results :14 males (56%) and 11 females (44%_ patients. The highest incidence of patients were in the (51- 60 years) age group (10/25, 40%). The most common presenting feature was abdominal mass (20/25, 80%). u/s and CT scan were the most reliable investigations in the diagnosis. The most common tumors were sarcomas (15/25, 60%) and lymphomas (5/25, 20%).
Conclusion :Although retroperitoneal neoplasms account for 0.1 - 0.2% of all malignancies (s), it seems that from our findings most of the tumors were malignant, where the sarcoma represents the common tumor among them, the presentations and the diagnostic modalities especially u/s and CT have a similarity with most of the studies reviewed.
Key words :Retroperitoneal tumors, types, presentations.

Background The Medicines and Health care products Regulatory Agency stated in 2003 that doctors should endeavor to avoid using products in treatments not covered by their product license. Foley catheters are commonly used in the management of epistaxis although their product license does not cover this.
Aims : To study the extent of the use of these catheters and the knowledge that otolaryngologists had of their legal status.
Method : By undertaking a questionnaire survey of some Otolaryngologists in Baghdad
Results : Most members appear to use Foley catheters in the management of epistaxis; however most of them are not aware that the product is not licensed for this purpose. Because of this lack of knowledge, only few obtain verbal consent for treatment with this device and none of the surveyed members obtain written consent from patients. Conclusion :In the era of increasing litigation, documentation of informed consent could be considered mandatory to protect us from possible legal action, and this needs to be known by all practicing Otolaryngologists.

Background: Clinical classification of patients with acute coronary syndrome is essential step in identifying severe cases before referring them, fairly quickly, for the ultimate investigation of coronary angiography .Hence it is important to find out the extent at which the severity of the disease, based on clinical classification, agrees with its severity at angiography and to see whether traditional Risk factors or pas ischaemia played a role.
Patients and Methods : The angiographer data of 178 consecutive pts with Acute Coronary Syndrome (ACS) were retrospectively analyzed. The pts consisted of 114 with Unstable Angina (UA) and 64 pts with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI). Patients were classified depending upon the predominating clinical assessment during hospitalization into four groups of progressively worsening ischaemia. They were; group 1; New onset Angina; 27 pts, group 2; Deteriorating Chronic Angina, 33 pts, group 3; Rest Angina 54 pts, and, group 4; Non-ST-Elevation Myocardial Infarction (NSTEMI), 64 pts.
Results : Coronary Angiography revealed that the frequency of multi-vessel coronary Disease (MVD) in group 1, 2, 3, and 4 were 48%, 73%, 72%, and 56% respectively which meant that worsening of ischaemia was not accompanied by commiserate increase of the frequency of MVD in Rest angina
and NSTEMI. To explain that we calculated the average number of Five traditional Risk Factors; Hyperlipidaemia (HL), Diabetes Mellitus (DM), Hypertension (HTN), Smoking (SM), and Positive Received March 2006 Family History (PFH) in the four groups ofACS (R.F. score) and they were 1.72, 1.87, 2.13, 2.51 in Accepted May 2006 groups 1,2,3, and 4 respectively. Then we studied the relation of having one, two, three, and four orfive Risk Factors and the frequencies of Multi-vessel disease and they were; 43%, 67%, 76%, and 84% respectively which meant that the frequency of MVD ought to increase from group 1 to group 4 supporting the clinical classification. This prompted us to look into the individual Risk factors. The clinical data showed that the incidence of HL had risen significantly in Ch. D. angina and Rest Angina (P: 0.03) and that the incidence of SM had risen significantly in NSTEMI (P.• 0.001). Since the angiographic data had demonstrated a significant association of HL with MVD and SM with SVD we may understand why the rate of MVD was not higher in NSTEMI than UA. To explain why the frequency of MVD in Rest Angina (g. 1) was not higher than Ch. D. Angina (g. 2) despite having worse ischaemia and higher R.F. Score we scrutinized the data and noticed that the main difference between group 1 and group 2 that chronic stable angina had preceded the onset of UA in Group 2 while it did not do in group 1. On the other hand Rest Angina and NSTEMI pis were a mixture of those with and without prior ischaemia. To follow this point further we divided both groups into two subgroups: one with history of prior ischaemia and one without it. The frequency of MVD in Rest Angina and NSTEMI with prior ischaemia were 83%% and 81 %% compared to 54% and 39% respectively in pts without it.
Conclusion this study has shown that clinical classification in Acute Coronary Syndrome may predict severity of the underlying CAD to some extent however considering the no. Of risk factors and which Risk factor and whether there was antecedent ischaemia would improve the prediction a great deal.

Background: Alcohol remains the single most significant cause of liver disease throughout the Western world, responsible for between 40 and 80% of cases of cirrhosis in different countries. Many of the factors underlying the development of alcoholic liver injury remain unknown, and significant questions remain about the value of even very basic therapeutic strategies.
Patients and Methods: In a cross sectional study, 113 alcoholic patients with evidence of liver disease in the absence of other significant etiology attending the Gastoenterorology and Hepatology Teaching Hospital between December 2001 and December 2003 were studied for the hematological and biochemical spectrum of alcoholic liver disease including Alfa fetoprotein (AFP) and gamma glutamyl transpeptidase alteration.
Results: The serum aminotransferase was mildly elevated and the AST/ALT ratio often exceeds 2.The serum bilirubin and PT positively correlated with the severity of ALD. The GGT was commonly elevated irrespective of liver damage. AFP was bellow normal in (80%) and was negatively correlated with the severity of ALD.
Conclusion: The hematological profile of ALD was macrocytosis and neutrophile leukocytosis. The serum aminotransferase was mildly elevated. The GGT was commonly elevated irrespective of liver damage. AFP was bellow normal in the majority and is negatively correlated with the severity of ALD.
Statistical analysis: Chi square tests and the mean value with SD for each value were determined using ANOVA. A p value of <0.05 was considered to be positive.

Background : The contribution of diastolic dysfunction in patients with preserved left ventricular (LV) systolic function to impaired functional status and cardiac mortality in myocardial infarction (MI) is unknown.
Materials and Methods : Assessment of LV diastolic function was performed by Doppler analysis of the mitral and pulmonary venous flow and the propagation velocity of early mitral flow by color M-mode Doppler echocardiography in 150 consecutive patients at day 5-7 following their first acute MI.
Results : Patients were classified into four groups: group A: preserved LV systolic and diastolic function (n=59); group B: LV systolic dysfunction with preserved diastolic function (n=8); group C: LV diastolic dysfunction with preserved systolic function (n=49); group D: combined LV systolic and diastolic dysfunction (n=33). The cardiac mortality rate at 6 months was significantly higher in groups C (12%) and D (36%) compared to A (2.5%) (p<0.01). Multivariate regression analysis identified LV diastolic dysfunction (p=0.001), killip class ≥II (p=0.005), and age (0.007) as predictors of cardiac death or readmission due to heart failure.
Conclusion : The presence of LV diastolic dysfunction is associated with increased morbidity and mortality following acute MI.
Key Words: Prognosis. Diastolic. Myocardial infarction
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Background: To shed some light on the clinical features of patients with Reiter's syndrome.
Methods: Reiter's syndrome in 50 patients (38 males and 12 females) was reported in a prospective study. All patients were subjected to detailed history, full clinical assessment and a slit lamp eye examination by an Ophthalmologist. A Dermatologist opinion was sought when needed and thorough laboratory and radiological investigations were made for all patients.
Results: Reiter's syndrome was post-dysnteric in 44 (88%) of patients and post-venereal in 6 (12%) patients. Its clinical features are similar to other series. Arthritis was noted in all patients, diarrhea in 44 (88%), eye lesions in 40 (80%) and mucocutaneous lesions in 37 (74%) patients but significant differences were noted between our study and others with respect to sex ratio, lower back pain, urethritis, oral ulcer, circulate balanitis. Tissue typing for HLA-B27 was positive in 72% of our patients
Conclusions: Reiter's syndrome is not rare in Iraq as previously thought. Physicians need to be more aware of its existence in young adult men who develop arthritis following dysentery

Background: Diabetes mellitus type-1 is the most common endocrine metabolic disorder in childhood. Mononeuropathy, generalized polyneuro-pathy and autonomic neuropathy are frequent complications of diabetes mellitus and may give rise to troublesome manifestations. Methods: sixty children suffering from type 1 diabetes mellitus admitted in Children Welfare Hospital- Medical City-Baghdad in the period from 1st Dec2000-31stJuly 2001 were included in this prospective descriptive study. History, especially symptoms of peripheral neuropathy, examination specially signs of peripheral neuropathy, absent sinus arrhythmia and postural hypotension and investigations like nerve conduction study were all performed and analyzed.
Results:
The study showed that out of 60 diabetic children 26(43.3%) had symptomatic polyneuropathy, 18 (30%) had postural hypotension and 16 (26.6%) had absent sinus arrhythmia. Neurological manifestations of diabetes mellitus occur frequently in diabetic children with long duration of illness.
Polyneuropathy is sensory more than motor and affected the lower limbs more than the upper limbs. Conclusion: Early diagnosis of autonomic neuropathy in diabetic children is simple easy and requires minimum cooperation, so as detection of peripheral neuropathy in asymptomatic by nerve conduction study.

Background : A retrospective study was done in the Pediatric ward /AL-Kadhimiyia Teaching Hospital on cases diagnosed as idiopathic thrombocytopenic Purpura admitted since the first of January1992 – the end of December 2004.
Aim of the study : The objective of this paper is to review the natural history of idiopathic thrombocytopenic Purpura , presenting feature and response to treatment.
Patients and methods : The review included age ,sex , clinical presentation , physical finding , complications , investigation ,treatment and course of the diseases .
Results: total number of the patients were 65, peak age was between (2 -5) years, 40 cases (61.53 %). Females were affected more than Males with male: female ratio of 1: 2.09 .There was no seasonal variation and all of the cases were preceded by viral upper respiratory tract infection .The main presentation was petechiae and ecchymosis, were found in all of them (100%) followed by epistaxis, 43 cases (66.15 %). In the majority the platelet count was < 20.000 X 10 9 /L, 32 cases (49.23 %) and the hemoglobin level was between 10 – 11gm /dl in most of them, 43 cases (66.15%). Steroid was the first line treatment, response occur within 2 – 3 weeks in the majority, 51 cases (78.46%). Chronic idiopathic thrombocytopenic Purpura occurred in 3 cases only (4.61 %).Splenectomy was done in 2 of them (66.66%). No mortality detected.
Conclusion : Idiopathic thrombocytopenic purpura is a mild disease with complete recovery in the majority of patients.

Background: The Aim Of This Study Is To Determine The Modalities Of Treatment Of GTD In Baghdad Teaching Hospital And To Assess The Efficacy Of Our Management Protocols.
Patients &Methods: Department Of Obstetrics & Gynecology- Baghdad Teaching Hospital. Retrospective Analysis Of Case Records Between January 1999 To December2000. 41 Patients' Data Were Reviewed For Age, Gravidity, Parity, Blood Group, Antecedent Pregnancy And Clinical Presentation At The Time Of Diagnosis. Monitoring Of Hcg Level Before And After Chemotherapy, Other Investigations Were Reviewed, Looking For Number, Size And Site Of Metastasis. The Patient Were Classified According To WHO Scoring System. We Evaluate The Lines )f Management, Chemotherapeutic Protocols And The Number Of Chemotherapy Courses For 'atient's Remission.
Results; The Most Common Presenting Symptom Was Vaginal Bleeding 70.7%. Dilatation And iuction Curettage Was The First Line Of Treatment, Although 4 Patients (9.8%) Ended With hysterectomy For Persistent Bleeding. Based On WHO Scoring System, Initial Assessment Shows That 78.04 % In The Low Risk Group, And 19.5 %In The Medium Risk Group And One Patient In The High Risk Group. Complete Remission Was Achieved With Administration Of 2- 7 Courses Of Single Agent Chemotherapy In 84.3 % In The Low Risk Group, While 5 Patient (15.6%) Show Resistance To Single Agent Protocol And Shifted To Combined Chemotherapy. Nine Patients In The Medium And High Risk Groups Started With Combined Chemotherapy. The Cure Rate In The Low And Medium Risk Groups Were 100%.
Conclusion; Chemotherapy Is The Main Line Of Management For Persistent GTD In Baghdad Teaching Hospital, And For The Low Risk Group We Found That Parantral MTX And Folinic Acid Had A Very Good Remission Rate And Patients Whom Developed Resistance , And Those In The Medium Risk Group Can Achieve Excellent Remission Rate With Multiple Agents Chemotherapy.

Background: Severe anaemia predisposes to infection particularly during pregnancy especially reproductive tract and urinary tract infection .Iron deficiency anemia is an important public health problem which contributes to morbidity and mortality in pregnant women, even milder anemia can cause urinary tract infection . Methods: This study was carried out during February to May 2005 among 200 pregnant women during their routine visits to the maternal and child health centers in different parts of Baghdad city , they were inquired carefully about their ages parity , their gestational age and examined physically in addition to testing their blood for lib concentration and urine for presence of bacteruria .
The sample was devided into two groups: The first group had confirmed diagnosis with UTI (100) , the second normal group (100) considered as a control. Results : The highest percentage of Urinary tract infected pregnants in the sample were nuillipara 44% and those in the second trimester showed highest percentage 57% of the sample . the mean blood 1 Ib was significantly lower in UTI cases (10.5 g/dl). the anemic individuals (<1 I g/ dl) constituted a significantly higher proportion (56%) of the UTI case
and the risk of having anemia in cases, of UTI is 4.5 times that of the control
Grand multipara with UT] increased the risk of having anemia significantly by 6.8 times compared to other and pregnants with UTI in second trimester of pregnancy increased the risk of having anaemia 14.9 times. Conclusion: We can conclude that there is an association between urinary tract infection and anemia of different causes during preguancv there is a high risk of having anemia amongst the complicated pregnancy with UTI in association with their parity , age and gestational age.

On one hand, laser medical systems are very useful in several medical fields. They are used for diagnosis and treatment. In addition, they are used in medical researches.
On the other hand, laser hazards may cause irreversible injuries, especially eye injuries. Therefore the safe use of medical laser systems is very important to protect the laser operators who are always exposed to laser hazards, and also to protect patients treated by medical laser.
This academic research was designed to achieve the safe use of laser medical systems in Iraqi hospitals by:
a- Knowing the basic laser concepts.
b- Concentrating on the responsibilities of the medical staff that operate the laser units. c- Identifying the anticipated laser hazards to the patients and laser operators.d- Presenting recommendations for the safe use of medical laser systems in Iraqi hospitals.

Background: The goal of this study was to determine the prevalence and the risk factors of asymptomatic pyuria in diabetic female patients.
Methods: The study included 100 diabetic female patients and 100 non diabetic females attending the outpatient in the period from Sep.2001 to Sep.2002.Patients with symptoms of urinary tract infection were excluded. Asymptomatic pyuria was defined as the presence of more than 10 leukocyteshigh power field in an uncentrifuged random urine sample.
Results: Diabetic women more often had asymptomatic pyuria than non diabetic women. The prevalence of asymptomatic pyuria was significantly higher in patients with duration of diabetes exceeding 15 years than those below. Diabetic females with asymptomatic pyuria more often had diabetic retinopathy, neuropathy, nephropathy, cerebrovascular disease, and ischemic heart disease than those without asymptomatic pyuria. As the degree of neuropathy increases it is accompanied by an increase in the prevalence of asymptomatic pyuria. The prevalence of asymptomatic pyuria was significantly increased in patients with proliferative diabetic retinopathy. As degree of nephropathy increases, it is accompanied by an increase in the prevalence of asymptomatic pyuria,
Conclusion: There is an increase in the prevalence of asymptomatic pyuria among diabetic females with complications of retinopathy, neuropathy and in nephropathy. The prevalence of asymptomatic pyuria increased with long duration of diabetes as diabetic microangiopathy becomes sever

Background: Cutaneous leishmaniasis is an endemic protozoal disease in Iraq. Recovery from the disease confers a solid and permanent immunity. Vaccination with a living inoculum of promastigotes isolated from culture reduce the incidence of disease.
Objective: To show the efficacy of different types of antigens for protection of Balb/c mice against cutaneous leishmaniasis.
Methods: Thirty Balb Ic mice were divided in to six groups, groups 1-4 were immunized with different types of antigens (heat killed, freezing-thawing, formalin fixed and ultrasonicated). Received June 2005 Group 5 was treated with freshly harvested viable promastigotes from liquid medium as positive Accepted Nov. 2005 control and group 6 was kept as negative control. Leishmanin test was used for estimation of hypersensitivity of skin. Results: Immunization with antigens preparation revealed that, the immunized mice became resistant to infection.
Conclusion: Immunization of mice against cutaneous leishmaniasis is possible by using different types of antigens. Key words: Immunisation, cutaneous leishmaniasis, mice.

Background: During the past several years, there has been a rapidly escalating clinical need to perform IHC stains that require quantitative interpretation. Automated Cellular Imaging System is used to analyze immunohistochemically stained slides, primarily for cancer-related diagnostics. Studies have shown that the device offers accuracy, precision, and reproducibility of immunostained slide analysis exceeding that possible with manual evaluation, which was the prevailing method.
Aim of the study In this article we will demonstrate that meaningful image analysis of immunohistochemical staining studies can be performed using inexpensive, widely distributed graphics software (Adobe Photoshop) on a personal computer. Also we will try to use a modified digital scoring system depending on the percentage of pixels that are showing a given stain with regard to the total area of the slide. We select three sets for each antigen (one is optimally stained, one is insufficiently stained and third one is not stained one)
materials and methods Thirty digital pictures of immunohistochemically stained slides with monoclonal antibodies against different antigens, from standard quality control lab (NORDIQC) and then were analyzed by Adobe Photoshop software, then we distribute the percent of pixels showing a giving band of the brown color into five groups, then we compare those results in the three groups.
Results: Results showed that there was significant difference between color bands of the same tissue among optimal and insufficient staining (P<0.05), also there was significant difference between the group of slides that were optimally stained with those insufficiently stained (p<0.05), that’s to say the procedure of scoring that was done was accurate in discriminating between optimal staining and insufficient staining
Conclusion: Each slide was converted into a matrix of data that describe every pixel in the slide and by that we can compare between all slides that’s to say we convert the visual manual evaluation into an automated objective analysis, which is the first step in establishing quantitative immunohistochemistry.

Background: to evaluate subcutaneous pancreatic transplantation in an experimentally induced diabetes mellitus in golden hamsters. Methods - many indexes (histological /using two stains, histochemical /using three enzymes, morphometrical and biochemical /blood glucose level) were employed in this assessment. Alloxan was used as ك-cytotoxic therapy (to induce diabetes mellitus), and cyclophosphamide was employed as immunosuppressive agent.
Results - high rate of success of transplantation (clearly evident by microscopical features of viable endocrine and exocrine tissue of transplanted pancreas and great tissue vascularization, normal enzymatic activities and significant lowering of blood glucose level) were elicited.
Conclusion – subcutaneous pancreatic transplantation should be thank about in treatment of diabetes mellitus.

Seventy- four cases of clinically diagnosed Rheumatoid Arthritis (RA), fifty cases of systemic lupus erythematosus (SLE), and thirty healthy normal controls were investigated for detection of rheumatoid factor (RF), total serum immunoglobulins (Igs), antinuclear antibody (ANA), and ANA subtype anti-double stranded DNA (anti-ds DNA).
Patients with RA showed 58.1% positive for RF comparable with 14% positivity in SLE patients and 6.6% in normal individuals. Serum Igs (IgA,IgG) were found to be elevated in RA and SLE patients (62.2% , 36.5%) (54% , 38%) respectively. This study revealed that ANA is found in 88% of SLE patients sera and 78% of these ANA is ds DNA in comparison with only 6.8% of RA sera were found positive for ANA.

Background: - Diabetic foot infections may be classified as superficial or deep. Bacteria are liable to enter any cut or ulcer causing infection. Defect in treatment of infected deep diabetic foot may result in oesteomyelitis, limb loss, and even death.
Methods: - Microorganisms were isolated and identified from both superficial & deep foot ulcers infection of (60) diabetic patients.
Results: - The present results showed that high incidence (30.8%) of Escherichia coli (E-coli) was isolated from dry - superficial foot ulcers followed respectively by Staphylococcus epidermidis (S. epidermidis). 3.1 % and 15.4% of Proteus mirabilis (P. mirabilis), equal Percentages for Klebsiellae Pneumoniae (K. pneumoniae), Klebsiellae ozaenae (K. ozaenae), Citrobacter freundii (C. freundii) and Pseudomonas aeruginosa (Ps. aeruginosa which were 7.7 %. the most common microorganisms isolated from wet - superficial foot ulcers were 14.3% of S. aurous and S. epidermidis, followed by equal by Percentages of E-coli, Enterobacter cloacae (E cloacae) k. pneumoniae, C. freundii; which were 9.5 % also equal Percentages for K. ozaenae, P. mirabilis, Morganella morganii (M. morganii) providencia rettgri (P. rettgri), Enterobacter. aerogenes (E. aerogenes), Acinetobacter baumanii (A. baumanii) & Ps. aeruginosa (4.8%) were isolated The present findings demonstrated that the microorganisms isolated from different depth of deep ulcer were 18.4% of Ps. aeruginosa, followed by equal Percentages (12.2%) of E-coli & P. mirabilis. Then 10.2% of k. Pneumoniae and equal Percentages 8.2% for both S. aureus& S. epidermidis, similar Percentages4.1 for Klebsiellae terrigina (K. terrigina) & providencia stuartii (p. stuartii). the other species from different other genera represent one (2.1 %) isolate only.
Conclusions:- The infected superficial ulcers from diabetic patients demonstrates high incidence of E¬coli followed by S. epidermidis, Proteus and Klebsiella. While the most common microorganisms isolated from wet-superficial foot ulcers were S. aureus, S. epidermidis, E.coli, Enterobacter, Klebsiella, Proteus, Providencia, Morganella, Citrobeacter, Acinetobacter & pseudomonas. The microorganisms isolated from different depth of deep ulcers were pseudomonas, E.coli, Proteus, Klebsiella, S. aureus, S. epidermidis, S.capitis, Streptococcus viridans, Shigella, Serretia, Acinetobacter

Background: Maxillary sinusitis is one of the most common infections of humans. Sinusitis can be defined as an inflammation of the membrane lining of any sinus, especially one of the paranasal sinuses. Objective: To determine the causative microorganisms of acute maxillary sinusitis
Patients: Forty five acute sinusitis patients were involved in the present study.
Methods: Sampling methods were per-oral nasopharyngeal swabs.
Results: Haemophilus species, Streptococcus pneumoniae (S.pneumoniae) and Moraxella catarrhalis (M.catarrhalis) were the most frequent isolates.
Conclusion: The most causative agents of acute maxillary sinusitis were bacterial isolates, which were Haemophilus species followed by S.pneumoniae and M.catarrhalis. the incidences of acute sinusitis were more common at patients' age (20-29 years old) groups.

Peroxynitrite is one intermediate of reactive nitrogen species with bactericidal and cylotoxic effects. Fluoroquinolones. drugs used for salmonella infections, are interacted vith nitrogen species and their baeterieida effect is influenced by these species. This study aims to assess serum peroxynitrite level in patients with enteric (typhoid) fever and. to investigate the effect of ciprofloxacin or amoxicillin on serum peroxynitrite level as well as in aqueous buffer solution in vitro. Thirty patients with enteric fever diagnosed clinically and serologically and twenty healthy individuals served as controls were admitted in this study. None of our sample was received anli-salmonellosis agents. Our results show that serum peroxynitrite level tended to be significantly less in patients with typhoid fever in comparison with controls. In in vitro experimental model, ciprofloxacin but not amoxicillin at 6.25 ug elevate significantly serum peroxynitrite level. In aqueous solution, the ability of ciprofloxacin to produce peroxynitrite is higher than that of amoxicillin. We conclude that Ciprofloxacin . as bactericidal agent against salmonellosis, may act via producing or elevating peroxynitrite level.

Background: Cadmium (Cd) is an industrial and environmental pollutant that affect adversely a number of organs in humans and other mammals.
Objectives: To study the effect of cadmium on liver of mice.
Material and Methods: Male Balb/c mice weighing 30-32 gm, 60 days old, were treated intraperitoneally (ip) with (1-10mg/kg body wt. /CdCl2). The body weight, liver weight, histological examination of liver, SEM, metal analysis along with DNA ladder for apoptosis.
Results: Cadmium induced both a time, and dose dependent increase in apoptotic, severity of necrosis. Liver weight, body weight decreased with increase of dose, while metal content was increased by increase of dose.
Conclusion: It has been concluded that cadmium caused necrotic effect on liver and apoptotic as well as decreased body weight and liver weight.
Key words: Cadmium, mice, metal analysis, apoptosis.

Background: The infertility affects about 20% to 28% of Iraqi population and the primary and secondary infertility cover 80% and 20% of infertility cases respectively. It has been shown that the major male infertility factors include oligospermia, astheno-spermia, teratospermia and azoospermia.
Objectives: The objective of this study was to compare the fertilizing capacity, in vitro embryonic developmental rate and embryo implantation following the use of epididymal, testicular, and ejaculated sperm in azoospermic and severely teratospermic men. Patients and Methods: The males in experiment one were divided into three groups, severely terato-spermic group (STSG, n=44), azoospermic-epididymal group (ASEG, n=35) and azoospermic-testicular group (ASTG, n=40). In experiment two the azoospermic patients were divided into two groups, obstructive (OASG, n=35) and non-obstructive (NASG, n=42). Both groups were underwent testicular extraction and intracytoplasmic sperm injection (TESE-ICSI) treatments.
Results: Concentration of FSH, LH, prolactin was significantly higher in non-obstructive group compared to obstructive group (P<0.001). The concentrations of testosterone and the volume of the testes were significantly higher in the obstructive group versus non-obstructive group (P <0.01). Percentages of the fertilizable oocytes and the number of the transferred embryos per patient in the ASTG group were significantly lower compared to STSG and ASEG groups. The pregnancy and implantation rates were not significantly different in the STSG, ASSEG, and ASTG groups. ICSI rate and embryo developmental rate and the number of the transferred embryos per patient were significantly lower in the non-obstructive group (NASG) compared to the obstructive group (OASG) Pregnancy and viable fetus percentages were similar between both groups (P>0.05).
Conclusions: Sources of sperm retrieval found to have no effect on embryo implantation and pregnancy rates when viable sperm are available for ICSI. Pregnancy and viable gestation sac percentages were not affected by the etiology of azoospermia in either obstructive, or non-obstructive with focal areas of spermatogenesis were present in testes of azoospermic men.

Background: Increase in marrow reticulin has long been recognized in primary myelofibrosis, but little was known about the reticulin structure of leukemic marrows, there has been a tendency to accept an increase in marrow reticulin as evidence of myelofibrosis. Similarly, there has been a tendency to diagnose as "acute myelofibrosis" cases of acute leukemia with brisk reticulin and early collagen production. This study was undertaken to determine incidence, type and pattern of fibrosis in the bone marrow of patients with acute leukemia, both acute lymphoblastic and acute myeloid leukemia.
Method: thirty-five bone marrow biopsy specimens from patients with acute leukemia were examined histologically; connective tissue stains were applied for stromal studies.
Result: an increase in marrow reticulin is common at presentation in patients with acute leukemia, effective anti-leukemic therapy results in resolution of the increased marrow reticulin.
Conclusion: The reticulin type of fibrosis is the common type encountered in acute leukemia which is of diffuse pattern, higher incidence of bone marrow fibrosis in patients with acute lymphoblastic leukemia than those with acute myloid leukemia. Fiber bone formation is found in 10% of cases of acute lymphoblastic leukemia ,but is not extensive and well developed as in cases of primary myelofibrosis.
Keywords: acute leukemia, bone marrow biopsy, reticulin content.
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Background: Neural tube defects (NTDs) are said to be inherited in a multifactorial fashion, i.e. genetic-environmental interaction. Maternal nutritional deficiencies had long been reported to cause NTDs, especially folate deficiency during early pregnancy. More attention had been paid to the exact mechanism by which this deficiency state causes these defects in the developing embryo. The most significant of all researches was that connecting reduced folate and increased homocysteine level in maternal serum on one hand and the risk of developing a NTD baby on the other hand.
Objectives : to determine the significance of homocysteine level in Iraqi mothers who gave birth to babies with NTDs as compared to normal controls.
Patients, Materials and Methods: Fifty Iraqi women having babies born with NTDS, referred to the genetic clinic in Baghdad Teaching Hospital, were included in this study (the study group) as well as 37 healthy women having normal children (the control group). This study was conducted from November, 2002 till October, 2003. Analysis of total serum homocysteine level for all women was done using a computerized HPLC system.
Results : the age of women in both groups was comparable (mean+SD in the study group was 26.2+5.14 years vs. 26.3+4.57 years in the controls). Among the study group, 4 (8%) had normal tHcy level; 44 (88%) had mildly elevated level, and only 2 (4%) had moderately elevated tHcy level, while all (100%) women in the control group had their tHcy level within normal level. This difference was statistically highly significant (p<0.001).
Conclusions : Women become at an increased risk of delivering a baby with NTD when having an elevated tHcy level in their sera, and that tHcy level is an important marker in maternal serum that is associated significantly with pregnancy outcome.

Purpose: To evaluate the frequency of visualization, thickness, and anatomical features of the normal appendix at nonenhanced helical computed tomography (CT).
Materials and methods : Two radiologists prospectively iterpreted, in consensus, the abdominal CT scans of 140 patients who were examined for renal colic assessment. They were blinded to patients' surgical history regarding a previous appendectomy. No contrast material was used. The frequency of visualization, and the two – wall thickness of normal appendix were recorded, as well as the anatomical features of the appendix and the effect of adequasy of intraperitoneal fat on identification of the appendix.
Results : The prevalence of appendectomy was 9% (13 of 140 patients). The sensitivity, specificity, positive and negative predictive values, and accurasy of visualization of normal appendix were 77%, 85%, 98%, 27%, and 77% respectively. The frequency of visualization was lower in patients with less nintraperitoneal fat. The mean thickness of normal appendix if no intraluminal content was visualized was 6.6 mm+ 1.0 mm, and the mean thickness excluding visualized intraluminal content was 3.6mm + 0.8 mm.
Conclusion : Most normal appendices are seen at nonenhanced helical CT. The thickness of normal appendix, when the content is not recognizable, overlaps the values currently used to diagnose appendicitis at CT.

Background: This research focuses on the characterization studies of 5v-Nucleotidase (5'-NT) of kala-azar patients' sera. 5V NT is one of the enzymes used as indicator of liver function test . In this study the optimum conditions for the activity of 5s - NT enzyme has been demonstrated for kala- azaric patients.
Materials and methods: Thirty five blood samples were obtained from Baghdad Hospitals from untreated infants and children with kala-azar. 5'-NT activity was measured by following the method of Wood and Williams.
Results: Optimum conditions of serum 5' - NT activity of kala- azaric patients obtained were 50 u L , 30 minutes ,0.8 mM,7.7 and 50'C) as (Volume of serum , incubation time , substrate concentration, pH and temperature) respectively