Journal of the Faculty of Medicine Baghdad

Back ground: This is a prospective study of Head injury in Najaf.
Aim: to study the causes & out come & way of transferring the rat to the hospital & best way to
investigate them.
Patients & methods:A prospective analytical study of 200 cases of Head injury patients, who
were admitted to Saddam Teaching Hospital , in Najaf between 18
t"
of November 1996 and
1st
of
September 1998.
Results: All age groups were included in this study, male to female ratio was 4:1 and the
highest incidence was seen at the age group below 14 years. The two most common causes of
head injury were road traffic accident (RTA)(51 %) and assault (22%),of RTA pedestrians accounted
for (87.25%). RTA accounted of (80%) in those with severe head injury. The highest incidence of
head injuries in both male and female was between 2pm and 6pm. All patients brought to hospital
by personal means, most of them reached the hospital within the first hour of injury. 115
patients (57.5%) were minor head injuries {Glasgow coma scale (11-15)}. Skull x-ray was
taken for 185 patients, it was positive for fracture in 48 patients (24%) and negative in 137
(68.5%). There is significant number of patients with negative skull X-ray who need not to be X-
rayed. The commonest associated injuries were limb fractures 35% followed by injuries of
abdominal viscera 11%. The incidence of operative treatment (10%). The final outcome on
discharge was complete recovery in 156 patients (78%) residual neurological deficits in 18
patients (9%), and death in 20 patients (10%), and 6 patients discharged against medical advice.
The common cause of head injuries in those who died was RTA 85%& we give recommendation
regarding traffic roads & culture of society & policy of investigation.
Key words :Road Traffic Accident (RTA). Glasgow come scale (GCS), Computed Tomograghy
(CT scan). In traventricular Hemorrhage (IVH) Disseminated intravascular coagulation
(DIC) Cerebrospinal fluid (CSF).

This prospective study involved one hundred patients with colostomies admitted at the Central Pediatric Teaching Hospital for colostomy closure over the period of two years (Jan.2000-Jan2002).
Patients were divided in to two groups according to the technique of colostomy closure. In the first group, the closure was done by single layer of interrupted non-absorbable suture material; in the second group closure was done by double layer suturing technique.
All patients were prepared by the same conventional method including fluid diet for three days followed by two days washing enemas before operation with antimicrobial prophylaxis agents. Of these one hundred patients;(48) presented as cases of Hirschsprung`s disease, (50) were cases of ano-rectal malformations, and (2) were cases of traumatic colonic perforation. According to the type of the colostomy; there were (62) loop colostomy, and (38) double-barreled colostomy.
According to the site of the colostomy; there were (84) patients with right transverse colostomy, (2) with left descending colostomy, (12) with sigmoidostomy, and (2) with cecostomy. Sixteen patients developed complications following colostomy closure; these were (wound infection, fecal fistula, small bowel obstruction, and other systemic infections).
We advise single layer bowel anastomosis for the following reasons:
1-operative time (anesthetic time) theoretically shorter with single layer closure.
2-less tissue handling (less trauma) with single layer closure.
3-less narrowing effect (as less suture material) on the already small bowel lumen. Too many sutures and too many knots leading to comprise blood supply with double layer closure.4-more cost benefit with single layer closure.

Background: To determine the efficacy of adenoidectomy in relieving symptoms of chronic sinusitis
in children.
Patients and methods :A prospective study carried out on 35 patients who underwent adenoidectomy
or Adeno-tonsillectomy between May 2004 and October 2005.The patient ages ranged from 3 to 12
years.
Five patients were unavailable for follow-up and did not complete the study so they are excluded
from. The pre-operative symptoms were Rhinorrohea, Nasal congestion, Headache, Postnasal
drainage, Cough, Halitosis and Irritability.
Also recorded was Mouth breathing, Fever and Frequent antibiotic use. Telephone interviews with the
patient\'s caregivers were conducted to collect information following the surgery regarding the presence
of the same symptoms as well as an estimate of overall improvement. Follow-up ranged from 5 months
to 1 year.
Results :The most frequently reported symptoms before surgery were Rhinorrhoea, Nasal congestion,
Mouth breathing, and Frequent antibiotic use. (26, 28, 24, 30 patients respectively). These numbers
decreased following surgery to (11, 12, 6, 24 patients respectively)
Complete or near complete symptom resolution was reported in 18 (60%) patients. Some improvement
was reported in 6 (20%) patients. Minimal or no improvement was reported in another 6 (20%) patients.
Conclusion In the majority of cases, symptoms of chronic sinusitis in children are relieved by
adenoidectomy.

Bakground: A prospective study was designed to find out the prevalence of different types of T.B.
among women and children.
Methods: A total of 390 patients aged from less than one year up to more than 65 years who attended
T.B. center in Kirkuk city from beginning to end of 2005, were included in the study. A detail clinical
and laboratory examination were carried out to confirm the diagnosis.
Results: The rate of infection in females (46.15%) was lower than males (53.84%).
In pediatric age groups, the highest rate was among the age 12-14 (2.05%) and the lowest was among
>1-2 years and 9-11 years (0.76%). Inactive pulmonary T.B. was highest among the pediatric age
group.
Conclusion: It is concluded that the rate of T.B. was high in both females and pediatric age group in
Kirkuk province. Inactive T.B. was highest among pediatric age group from 12-14 years.

Background A high prevalence of Behaviors which is related to persistent diarrhea and the
prevalence of moderate to sever malnutrition in patients with persistent diarrhea in children.
Objectives To asses the prevalence of negative behaviors that causes the persistent diarrhea
and to asses the prevalence of malnutrition among children with persistent diarrhea and to
compare prevalence of malnutrition due to persistent diarrhea to that of national figures.
Patients and Methods This study was carried out at the Central Teaching Hospital for
Children in Baghdad, a total number of 200 cases of persistent diarrhea (lasting more than 14
days)\"with no more than 48 hour normal bowel motions in this period\" in children less than 2
years of age. The period of the study was one year from the 1st of January 1999 to the thirty-one
of December 1999. Information was taken from patient\'s companions usually the mothers and
the patients were selected at Inpatient, out patient and Emergency departments in a randomized
way.
Results. The study showed that the most common age group of persistent diarrhea was the 2nd
half of the first year constituting (47%) (94/200) of patients with persistent diarrhea. Patients
whose mothers were illiterate constituted a high proportion (48%) (96/200). Patients on bottle
or mixed feeding constituted (77%) (144/200). A high prevalence of some behaviors which is
related to persistent diarrhea was noticed like allowing the children to pick up food spilled on
the floor and eat it (65%) (130/200), stopping or altering feeding during episodes of diarrhea
(78%) (156/200), mothers neglecting washing hands or their babies hands before feeding their
children (74%) (148/200) and (66%) (132/200) respectively, failure to introduce solid food in
1st year of life (72.3%) (94/ 130) and failure to eat adult type of food in 2nd year of life (65.7%)
(46/ 70). The prevalence of moderate to sever malnutrition at the three age groups was
significantly higher in children with persistent diarrhea in present study compared to general
population figures reported by polio immunization national day (PIND) survey at 1999 in Iraq,
marasmus was significantly more common in 2nd half of the 1st year of life and the prevalence
of kwashiorkor was significantly higher (15.8%) (11/70) among the older age group (2nd year
of life)
Conclusion. The most common age group who developed persistent diarrhea was the second
half of the first year of life. The negative behaviors of the mothers had a significant effect on the
occurrence of persistent diarrhea in children and the development of malnutrition diseases like
marsmus and kwashiorkor

Background: vomiting is a very common symptom of disease in childhood, it occurs both in
gastrointestinal and non-gastrointestinal diseases.
Objectives: Our aim of the study was to find out the causes of vomiting in different age group, the
improper management of vomiting in daily practice and to emphasis on the usefulness of imaging
study in the diagnosis.
Methods: A prospective study was carried out on patients presented with vomiting admitted to
Children Welfare Teaching Hospital from the first of Dec. 2001 to the end of April 2002 .The age
ranged between early neonatal periods to 12 years of age.
Reults: A total of 100 child were included in this study,(65) male (35) female male to female ratio
was1.86:1. Surgical causes of the gastrointestinal tract was the most common cause of vomiting (50
%) in the neonatal period, while infectious cause formed 78.3% & 48.4% during infancy and
childhood respectively.
Imaging studies was carried out on 54 patients and helped to reach a final diagnosis in 21(38,9% )
patients.
In this study green color vomiting was found to relate mainly (64.7%) to the intestinal obstruction
with a (p) value >0.05.
Conclusion: There was no benefit of antiemetic drugs in the treatment of vomiting, Imaging studies
were helpful in reaching the correct diagnosis of vomiting in some cases, green color vomiting
should make pediatrician suspicious of intestinal obstruction.

Background: Congenital malformations are responsible for a considerable proportion of
perinatal, neonatal and infant mortality in many Eastern Mediterranean countries. So this study
aims to find out the incidence, types and probable risk factors of these malformations in Baghdad.
Patients and methods: one hundred cases of congenital malformations were studied out of 8090
neonates born in 4 hospitals in Baghdad province over 5 months in 2002 (preterm, term) .The
incidence , types and risk factors were analysed .
Results: the incidence of congenital malformations was 12.36/ 1000 live births, with the central
nervous system malformations being the commonest. There is increased risk in consanguinous
marriages 27 (27%), mothers not attending antenatal care 25 (25%), mothers of low gravidity 60
(60%), and mothers not taking folic acid during pregnancy (86.7%).
Conclusion: Consanguineous marriages and mothers not taking folic acid during pregnancy are
important risk factors for the occurrence of congenital malformations .So I recommend genetic
counseling especially for consanguineous marriages, and giving all pregnant women folic acid
before and during pregnancy. A multicentre study will give more broad idea about the incidence ,
types ,and risk factors in our country

Background: Outcome of management of patients with diabetic foot is difficult to predict. Assessment
of variables in history , examination and investigations were analyzed with outcome of management and
whether can be assigned as prognostic factors .
Methods: prospective study of 300 patients with diabetic foot in Baghdad teaching hospital during
the period from April 2000 to March 2004,certain criteria was taken in history and examination, these
were investigated and treated either by conservative procedure or amputation.
Results: most common age group was 50-59 years ( 33.3%). The male to female ratio was 2:1.
Conservative debridement was performed in ( 60%) of patients while amputation was employed in
(40%). amputation was performed in 604 in patient above 60 years and in(75%) of patients who had
diabetic foot lesions for > 2 weeks,and in 90% of smokers for 10 years or more. Amputation was
needed in (71%) in those who had history of previous ulceration and 72.5% of patients who had
positive history of previous amputation. Amputation was needed in (88%) of those who had their
temperature >38°C. in (91%) of patients who had diabetic foot lesion of Wagner grade>III and 91%.
patients with X-ray findings of osteomyelitis.
Conclusions: Highly significant association was found between amputation with following variable ,
smokers > 10 years, patients with a temperature of > 38°C, Hypertension > 140/90 mmHg Wagner
grade > III, white blood cell count of > 20,000/cc and positive foot X-ray findings. Slight
significant association of amputation and the following variables: Age >60 years, duration of foot
lesion >2 weeks, history of previous amputation, previous ulceration, negative pedal pulses, deformed
feet and patients who had impaired normal vision.

Background: Diabetic maculopathy means involvement of the macula by edema and exudates
or ischemia which is the most common cause of visual impairment in diabetic patients,
particularly those with type 2diabetes.
Objective: The literatures are rich in publications of these regards, nevertheless the works
in general were not systematic, not enough details regarding procedures and dose
parameters in using laser for treatment are mentioned. "In the present work, an attempt to
build a systematic procedure regarding dose parameters, application parameters and laser
safety."
Methods: A frequency doubled Nd: YAG laser was used to treat all eyes included in this study
with diabetic maculopathy. Forty eyes of twenty five non insulin dependent diabetic Iraqi
patients were evaluated, sixteen males and nine females. Their ages were 42- 76 years, all
of them from patients attending ophthalmic out-patient department in the medical city.
Results: Maculopathy regressed in 38/40 of the treated eyes, unchanged in 2/40 eyes and
no one was deteriorated. Visual acuity improved in 6/40 of the treated eyes by at least
two lines of Snellen's chart while it stabilized in other 34/40.
Conclusion: Exudative diabetic maculopathy is responsible for reduction in vision and even
legal blindness in many patients. Close regular follow up and early laser treatment of eyes
with maculopathy is significant in stabilization of vision and reducing the rate of visual loss.

Background: Acute Promyelocytic Leukemia (APL) is commonly associated with disseminated
intravascular coagulation (DIC) and early correction of coagulopathy is of vital importance. All
Trans-Retinoic Acid (ATRA) is considered to be the drug of choice in the treatment of APL.
Objective: The work was conducted to
1- Identify patients with APL who show laboratory evidence of DIC. J Fac Med Baghdad
Vol. 49, No. 1, 2007
Received: June 2006
Accepted: Nov. 2006
2- Study the serial changes in haemostatic parameters in APL patients treated with ATRA and to
compare their results with those treated with conventional chemotherapy without ATRA.
Subjective and methods: In this prospective study (from October 2003 to October 2005), 44 newly
diagnosed, untreated APL patients were included. ATRA plus chemotherapy – treated patients were
24 while 17 patients were treated with chemotherapy other than ATRA. For each patient, a full
clinical evaluation was done and hematological investigations were accomplished at time of
diagnosis and repeated on day 3 and 7 of therapy.
Diagnosis of DIC was based on finding a positive D- dimer test with hypofibrinogenaemia with or
without pathologically prolonged (PT and/or APTT).
Results: In 44 newly diagnosed, untreated APL patients studied, the age range between 6-81 years
with a median of 27 years. Male to female ratio was 1.3:1.
Before treatment all patients had anemia, thrombocytopenia, and elevated level of D – dimer. DIC
was present in all patients at time of diagnosis. All parameters that showed abnormal level at time
of diagnosis had returned to normality within one week in ATRA treated group, indicating that DIC
has essentially resolved. By contrast, those parameters remained abnormal even on day 7 in the
chemotherapy treated group. Indicating that DIC was on going.
Conclusion: ATRA therapy in APL patients is associated with rapid improvement of coagulopathy
therefore , it is justified to be used from day one of the treatment.

Background: Heart failure is a common clinical syndrome with a high morbidity and mortality, despite advances in medical treatment. Death from dangerous ventricular arrhythmias is frequently implicated.
Patients, materials & methods: Eighty patients with heart failure (HF) (fitting the criteria of heart failure) who were admitted to the medical city teaching hospital during a period of 8 months, were studied for incidence of nonsustained ventricular tachycardia (N.S.V.T.) (detected by Holter monitoring) and its association with the severity of left ventricular dysfunction (measured by ejection fraction), ventricular size (measured by left ventricular end diastolic dimension), and other factors .
Results: It was found that out of 80 patients with H.F, 20 patients (25%) have N.S.V.T. N.S.V.T was found to be significantly associated with the severity of H.F. and left ventricular dimension. Hypertension (HT) remains poorly controlled even in the developed countries in spite of the
improvement in management. Many studies found that about 70% of people with HT remain
uncontrolled. The aim of this study is to determine the proportion, and determinants of
uncontrolled HT (UHT) among treated hypertensive patients. A random sample of 214 known
hypertensive patients, on regular treatment for a minimum of one year was included. The mean of
three blood pressure (BP) readings measured two weeks apart was considered. Controlled BP
was defined as systolic BP≤140mmHg, and diastolic BP≤90 mmHg. A questionnaire was used to
collect data on certain demographic variables (age, gender, marital status, educational status,
crowding index), smoking habit, salt, and alcohol intake, number of used antihypertensive drugs,
frequency of BP checking, co morbid illnesses, and certain anthropometric measurements. The
proportion of UHT is 68%. Although the proportion of UHT was higher among older age
patients, males, currently married, college graduate, those using three antihypertensive drugs,
patients with no dietary salt restriction, or no co morbid illnesses, but these factors were not
proved to be statistically significant. Current smoking, Body Mass Index (BMI) ≥25
Kg/m2(reflecting overweight/ Obesity), and frequency of BP checking were statistically significant
predictors of UHT.

Background: Heart failure is a common clinical syndrome with a high morbidity and mortality,
despite advances in medical treatment. Death from dangerous ventricular arrhythmias is
frequently implicated.
Patients, materials & methods: Eighty patients with heart failure (HF) (fitting the criteria of
heart failure) who were admitted to the medical city teaching hospital during a period of 8
months, were studied for incidence of nonsustained ventricular tachycardia (N.S.V.T.) (detected
by Holter monitoring) and its association with the severity of left ventricular dysfunction
(measured by ejection fraction), ventricular size (measured by left ventricular end diastolic
dimension), and other factors .
J Fac Med Baghdad
Vol. 49, No. 1, 2007
Received: April 2006
Accepted: June 2006
Results: It was found that out of 80 patients with H.F, 20 patients (25%) have N.S.V.T.
N.S.V.T was found to be significantly associated with the severity of H.F. and left ventricular
dimension. The arrhythmia was found to be strongly related with hypokalemia. The incidence of
N.S.V.T. is less in patients receiving beta-blockers in their treatment regimen.
Conclusion: Nonsustained ventricular tachycardia is a common finding in heart failure and is
related to the severity of heart failure and other factors related to the disease and its treatment

Objectives: To document electromyographic changes in thyrotoxic patients, and to categorize the type of myopathic process in thyrotoxicosis.
Design: This case control study was designed to show the electromyographic changes in thyrotoxic patients and to compare these findings with that of normal aged matched controls to show the significance of these changes in thyrotoxic patients. Student’s test was applied on the results and P value was extracted.
Subjects: Subjects in this study were chosen according to certain criteria depending mainly on their blood level of thyroid hormone (T3, and T4) and TSH. All of them are thyrotoxic patients, their ages range between 15 to 45 years. They were 25 patients (15 female and 10 males). Another 25 subjects were chosen as normal controls they were of the same age and sex, patient with features of myopathy or neuropathy from diseases other than thyrotoxicosis were excluded carefully from studied patients and the normal controls.
Results: EMG finding in thyrotoxic patients was as follows: No spontaneous activities in the proximal muscles (deltoid and in rectus femoris muscles). The amplitude of the motor unit action potentials was ranging between (200-800 microv) with a mean of (488.8 +/- 159.3microv.) in the deltoid muscle, while the amplitude of the action potential In rectus femoris muscle in thyrotoxic patients was ranging between (350-900 microv.). In abductor pollicis brevis muscle the action potential amplitude in thyrotoxic patients was ranging between (500-2150 microv.), there was significant difference between thyrotoxic patients and normal controls. The duration of the motor unit potential in thyrotoxic patients was ranging between (7—11.5 msec.) with a mean of (8.51+/- 1,24 msec) in the deltoid muscle, slightly higher figures in rectus femoris muscle, this indicates significant difference in the duration of action potential between patients and normal controls. The other parameters of EMG study all indicate a myopathic process involving proximal muscles in 76% of thyrotoxic patients and a neuropathic process involving distal muscles in 28% of thyrotoxic patients.
Conclusions:
1-thyrotoxicosis involves proximal muscles more than distal muscles.
2-myopathic process in thyrotoxicosis can be observed clearly in EMG study of the proximal muscles.
3-EMG findings in thyrotoxic myopathy includes, short duration polyphasic potentials, with early recruitment full interference pattern.
4-Distal muscles in thyrotoxic patients may show EMG findings of a rather neuropathic process.

Background: pain is frequently listed among initial symptoms of MS or an occurring in the course of the disease.
Patients and Methods: one hundred thirty MS patients diagnosed according to Macdonald's criteria compared with 115 matched age and sex control were interviewed about pain Neuropathic, somatic and headache.
Results: Neuropathic pain was significantly higher in MS than control group, while LLD and ARP were of no significance difference between two groups. For somatic pain there was significant increase in MS.
Conclusion: pain is common in MS especially LLD. There is no significant difference between pain subtypes and duration of disease and FS, EDSS.

Background: This study comprises two parts. "['his part deals with epidemiology, aetiology
and clinical features of brain abscess during a 10 years period, while the second will deal
with diagnostic investigation, management and final outcome of brain abscess
Methods: The case records of patients with brain abscess admitted to the neurosurgical
specialties hospital in Baghdad over a 10 years period extending from 1" Jan. 1993 to 31S
`
Dec. 2002, inclusive were reviewed. Data obtained included demographic and clinical data.
Results: A total of 78 cases (1.2% of total admission) of brain abscess were admitted. Their
age ranged from one month to 68 years. The most common' aetiological (actor was cyanotic
heart disease, with the congenital anomaly being unrepaired in all cases. Remote infection foci
other than heart represent minority. Half of the cases had a rapid onset and fluminant
progression. The presenting features of the patients older than one year were raised
intracranial pressure, and focal neurological deficit and infection.
J Fac Med Baghdad
Vol. 49, No. 1, 2007
Received: May2006
Accepted: Sep. 2006
Conclusion: Maintaining a high index of clinical suspicions in patients having one of the
infection sources together with neurological signs should be emphasized. '.

Background : Left main coronary artery (LMCA) disease represents important and serious portion of coronary artery disease(CAD).
Aim: The aim of this study is to estimate the incidence of LMCA disease among patients with CAD undergoing coronary artery angiography and to evaluate clinical characteristics of patients with LMCA disease.
Methods: The study involved review of clinical notes and coronary angiography of 1020 patients with CAD in Ibin Al Bitar hospital for cardiac surgery between April and September 2004.This review included evaluation of electrocardiogram (ECG), echocardiogram(ECHO),
ECG exercise test (EET) and coronary angiography.
Results: Among 56 patients proved to have left main coronary artery (LMCA) disease,40 patients had complete data available which were studied.
Mean age of patients with LMCA disease was 60 ± 8.07 years, 82% of them were males, 62% were smokers, 40% were diabetics and 55% were hypertensive.
In this group 62.5% of patients with LMCA disease presented as acute coronary syndrome (ACS) and 37.5% as chronic stable angina (CSA),normal left ventricular (LV) function was found in 75% of patients and 40% have normal electrocardiogram (ECG).
Patients with LMCA disease who have distal involvement represent 75%,15% have diffusely diseased LMCA, right coronary artery (RCA) was involved in 80% of patients and those with RCA involvement were more commonly presented with ACS (78%), while those without RCA involvement presented more as CSA.
Those patients who underwent ECG exercise test had poor functional Capacity, with mean exercise duration of 3.7 ± 2.3 minutes and mean metabolic equivalents (METs) of 4.5 ± 2.46.
The tests were positive in 76.9% of patients inconclusive in the rest but no negative tests were recorded.
No significant differences were observed between those patients with ACS and those with CSA in regard to patients' characteristics.
Conclusion: LMCA disease is not uncommon among those with CAD, it occurs in patients with multiple cardiovascular risk factors. Patients with LMCA disease usually have poor functional capacity and their ETTs are commonly positive and of high risk score. Involvements of right coronary artery (RCA) in addition to LMCA render the patients more unstable.

• Causes of Laser Hazard
I - Inherent Hazards to Laser Beam
Direct or reflected laser beams have consequential
health effects range from minor skin burn to
irreversible eye injuries. The hazards depend on the
power output and wavelength of the used laser and
depend on the exposure time and MPE. ti & 2)
A- Eye Hazards
Point light source cause more damage to eyes
than large sources, because point sources
concentrate into a very small point on the retina
with a high power density. So direct laser beam
or specular reflected laser beam cause more
damage than diffusely reflected laser beam.

Background: To elucidate distinctive CT imaging features that allows a diagnosis of hepatic
hydatidosis.
Patients and methods : The computed tomographic (CT) findings of 58 patients with
sonographically detected cystic liver lesions were prospectively analyzed. These patients were
followed up until a final diagnosis was reached.
Results : By CT scanning we correctly localized and diagnosed 81 hepatic hydatid cysts in 50
patients. These were all proved by surgery or endoscopic retrograde cholangio-pancreatography
(ERCP). Stage III and II hydatid cysts were the commonest types (29 % and 25 % respectively ).
52 % of the cysts were 5-10 cm at presentation. At CT, we identified some ancillary imaging
features that help in the diagnosis of unilocular type I hepatic echinococcal cysts.
Conclusion : Although no imaging feature can provide a definitive diagnosis of a unilocular type
I hepatic echinococcal cyst, some ancillary imaging features may help in differentiating them
from a non parasitic simple liver cysts. Types II, III, & V hydatid cysts, on the other hand, have
characteristic imaging features that allow their confidant diagnosis.

Background To evaluate the sensitivity, specificity, accuracy, positive predictive value (PPV),
and negative predictive value (NPV) of ultrasonographic and doppler US findings in the
diagnosis of acute appendicitis.
Method : A total of 115 cases of clinically suspected appendicitis were prospectively examined
by grey scale US and doppler US. Five patients were excluded from the study because of
difficulty to perform the graded compression technique. In the other 115 patients who were
included in the study population , US appendiceal and periappendiceal signs, as well as doppler
US findings were evaluated. Definitive diagnosis was established at surgery and histopathological
examination in 62 patients (59 patients with appendicitis & 3 patients with alternative final
diagnosis), and at clinical follow up in 48 patients.
Results : The prevalence of appendicitis in this study was 54%. The appendix was identified in
80 (73 %) of the 110 patients , which included 55 (93 %) of 59 patients with appendicitis & 25
949 %) of 51 patients without appendicitis. The most accurate appendiceal finding for
appendicitis was a diameter of ≥ 6 mm & non compressibility, which both had an accuracy of 96
%. The lack of visualization of the appendix had a NPV of 87 % , while the visualization of a
normal appendix with a diameter of < 6 mm had a NPV of 96 %. Inflammatory periappendiceal
fat changes had a sensitivity of 92 % , PPV of 83 %, & a NPV of 89 %. Hyperaemia in the
appendiceal wall, although had a low sensitivity (53%), it had both high specificity (92 %) & high
PPV (94 %). The other findings had both low PPV & NPV.
Conclusion : A non compressible appendix with a threshold outer diameter of 6 mm under
compression is the most accurate US finding for appendicitis; with high sensitivity, specificity,
PPV, & NPV.

Background: Ovulation induction by human menopausal gonadotrophin (HMG) results in temporal
luteal phase defect. Luteal support therapies are required to support embryo implantation in stimulated
cycle especially in luteal phase defect infertile women.
Objective: The objective of the present study was to investigate the clinical significance of progesterone,
aspirin and HCG on human embryo implantation in women with luteal phase defect following ICSI and
embryo transfer (ET).
Patients and Methods: The female patients were divided into six groups depending on the type of the
luteal support protocols (LSP). Group 1 (No= 54), received 10 mg oral progesterone (P), group 2 (No=
35) received P plus HCG, group 3 (No= 59) received P plus HCG plus oral aspirin, group 4 (No= 47)
received vaginal P administered 24 hours before embryo transfer plus oral aspirin, group 5 (No= 40)
received vaginal P administered 12 hours after embryo transfer plus oral aspirin and group 6 (No= 46)
received intramuscular P plus oral aspirin. The LSP were continued for at least 12 weeks, when the B-
HCG test was positive, (tested two weeks after embryo transfer).
Results: Statistical analysis of the clinical data showed no significant differences between the LSP in
regard to patient's age, body mass index (B/M2), basal FSH/LH ratio and estradiol concentration at the
day of HCG injection. The ICSI rate, percentages of embryos developed in vitro, and the numbers of
the transferable quality embryos were similar in all groups (P>0.05). The pregnancy rate was
significantly higher (P < 0.05), in group 4 compared to other groups (38.66% versus 24.51%(G 1),
22.53% (G 2), 28.66% (G 3), 25% (G 5), 21.60% (G 6). The percentages of viable fetal sac development
per patient were 31.49 (17/54), in G 1, 42.86 (15/35), in G 2, 49.16 (29/59), in G 3, 59.58 (28/47), in G
4, 32.50 (13/40), in G 5, and 34.79 (16/46), G 6. The percent of viable gestation sac was significantly
higher in group 4 compared to other groups (P < 0.05).
Conclusions: The administration of 400 mg /day vaginal progesterone 24 hours before ET and
100 mg/day aspirin five days after ET results in significant improvements in pregnancy and embryo
implantation rates and development of viable fetuses in luteal phase defect infertile women undergoing
ICSI-ET.

Background: Tinea versicolor is a common dermatological problem ,world wide distribution ,
caused by a dimorphic fungus called Malassezia furfur ,it live normally on skin as a commensal .
Many factors play a role in the etiology of TV among these could be the disturbed immune system
which may be related to the ability of TV alter the immune system by a process called
Immunomodulation leading to subsequent infection.
Immuno-inflammatory activity mediated by different cytokines could have a role in the etiology
of TV.
Objective: To evaluate the serum level of the inflammatory cytokines ,IL-4andIL-8,in patients with
TV as compared to immunocompramized patients and healthy groups.
Patients and methods: This study enrolled 50 total patients, 15 of them were as patients control
group who were immunocompramized with evident skin lesion ,to be compared serologically with 15
patients who had TV and normal immunity, the control group composed of20 healthy volunteers.
Using ELISA test technique the following tests were done :detection of IL-4 and IL-8 in the sera of
all groups.
Results and discussion: The statistical differences in the rate of detectable IL-4 level between TV
and healthy control p< 0.001,while the difference was a highly significant between the healthy
control and immunocompramized patients with TV,P<0.00338.The difference between two
diseased groups was(p< 0.219)which is non significant , when p<0. 05 was considered significant.
IL-8 the results of our study showed a significant difference between the healthy control and the
patients with tinea versicolor, p-value was( 0.05).
In this study there was a nice findings by which the difference between the healthy control and the
immunocompramized patients was highly significant as ,p<0.005.
Conclusion :The genus Malassezia is an immunological paradox. In some circumstances, it acts
as an adjuvant, activates the complement cascade, and elicits both cellular and humoral immune
responses in healthy individuals, among which IL8 and IL-4 were notably increased . In contrast,
it also seems to have the ability not only to evade the immune system but actually to suppress the
response directed against

Background: Asthma is an allergic hypersensitivity disease in which many mediators play a role in
its pathogenecity. One of these etiological agents is the mediators such as Interleukin-5 (IL-5). The
aim of this study to demonstrate the association between IL-5 and obesity in asthma development.
Materials & Methods: One hundred and four sera samples for asthma cases have been studied in
comparison with 41 non-asthmatic bronchitis as a patient controls beside 30 apparently healthy
controls. Cytokine has been estimated using ELISA method in correlation with Body Mass Index
(BMI).
Results: This study revealed a significant correlation between IL-5 concentration and BMI
(P<0.05), particularly among females.
Conclusion: There is certain correlation between obesity and asthma accompanied by IL-5. Key

Propolis is a complex resinous bee product that has a wide range of biological activities. In the
present investigation, two oral doses (10 and 20 mg/kg/day) of propolis (ethanol extract) were
evaluated immunologically in albino male mice (80 animals) through three types of experiments. In
the first, the propolis was tested alone, while in the second and third experiments, propolis was given
before and after the immune suppressive drug MMC (pre- and post
treatments, respectively). The three experiments were paralleled with three negative controls, in
which the propolis was replaced with distilled water. In the first experiment, the dose 10 mg/kg of
propolis enhanced the parameters investigated, and a significant increase was observed in the total
count of leucocytes (10.7 vs. 7.8 x 103 cells/cu.mm.blood), lymphocytes (7.0 vs. 5.3 x 103
cells/cu.mm.blood), neutrophils (2.9 vs. 2.1 x 103 cells/cu.mm.blood), monocytes
(0.5 vs. 0.3 x 103 cells/cu.mm.blood) and eosinophils (0.3 vs. 0.1 x 103 cells/cu.mm. blood), PI (15.2
vs. 10.8%), PFC (72 vs. 38%), AR (0.84 vs. 0.57 mm) and DTH (0.68 vs. 0.40) as compared to
negative controls. Much more enhancements were observed in the dose 20 mg/kg. In the second and
third experiments, a similar picture was drawn in the interaction of propolis (pre- and posttreatments)
with MMC, in which the propolis extract was able to modulate the immune suppressive
effect of MMC, and this was dependent on the type of treatment and dose, and again, the dose 20
mg/kg was more effective in this respect.
Key words and Abbreviations: Arthus reaction (AR), Delayed type hypersensitivity reaction (DTH),
Mitomycin C (MMC), Phagocytic index (PI),
Plaque forming cells (PFC), Propolis and Sheep red blood cells (SRBC).

Background: Transitional cell carcinoma of the urinary bladder is one of the important
malignancies in both sex groups .It is considered as a heterogenous neoplasm with different
biological behavior, in which the majority are early non invasive with tendency for recurrence and
some may progress to invasive tumor. An important clinicopathological features are ,the tumor
stage and histological grade which are used as prognostic parameters of the tumor and play an
important role in therapy. Due to the subjectivity of the histological grading , the reproducibility
was low . Many studies showed the value of quantitative analysis of the tumor as an important
method in determining the recurrence of the tumor and muscular invasion, some other studies
showed the value of nuclear measurement as a prognostic tool for bladder carcinoma.
Aim of the study: To evaluate the benefit of nuclear image analysis as an objective method for
grading of transitional cell carcinoma of the urinary bladder and compare it with the subjective
routine histological grading.
Material and method: Sixty two cases of transitional cell carcinoma of the urinary bladder,
histologically diagnosed and graded according to WHO grading system ,were selected . In each
case 8-10 HPF were examined &10-20consecutive cells were studied, also we measured the largest
10 nuclei for each case separately by a computerized image analysis system at x400 magnification.
Nuclear area and roundness were determined. Statistical analysis was performed using the analysis
of variance and Tukey’s test (HSD).
Results: There was no statistical difference in the mean value of nuclear roundness between the
three grades (P<0.05), while there was a statistical difference between grade I&III of their mean
nuclear area (MNA) &MNA of the largest 10 nuclei (P<0.05). No such difference was found
between grade I&II or grade II&III (P<0.05).
Conclusion: Morphometric analysis should be based on the selection of special areas and not by
random measurement as done on routine histological grading.

Management of preterp'labour generally treated by salbutamol even with some expected
disturbing
-
maternal pulmonary oedema , respiratory distress and
cardiovascular side effects and neonatal low-sized and cellularity of thymus and lymph nodes .
This demands finding a substitute free of these side effects . Initially, acetaminophen was tested
on rats uterine horns and on pregnant rats and reported an effective relaxation of the uterine
horns and profound delay in parturition . These results jestified an in-vitro study on strips of
gravid human uterus ruptured during difficult labour. Acetaminophen (50 mg) reduced
tension by 50% which was comparable decrease in tension when 5 gg of salbutamol was added.
Profound drop in tension when adjunct use of both drugs, while repeated three doses of 50
mg acetoaminophen were added separately resulted in corresponding drops in tesion down to
below resting level . These findings encouraged future clinical trials on threatened women
with abortion since the use of acetaminophen in the usual dosage is effective tocolytic agent
without any maternal side effect but with mild possible neonatal lung congestion as a result of
transient narrowing of ductus arteriosis especially in advanced gestation age.

Background: Pityriasis rosea is an acute, self-limiting skin disease, probably of infective
origin. Doxycycline is a broad-spectrum antibiotic, and most probably has an
immunomodulator and an anti-inflammatory effect.
Objective: To assess the efficacy of doxycycline in the treatment of pityriasis rosea in patients
evaluated between January 2001 and May 2002.
Patients and methods: This was a placebo-controlled clinical trial. One hundred and twenty
patients with pityriasis rosea were included in the study; all of them were above 12 years of
age. They had been divided into 2 groups, the treatment group consisted of 60 patients and
received doxycycline capsule. 100,mg orally for 14 days and the placebo group consisted of
60 patients and received glucose capsules for 14 days, all the patients were followed up
clinically for 4 weeks after treatment, the responses were categorized into excellent, partial
and no response.
Results: forty-six patients from the treatment group completed the study. Excellent
response was achieved in 30 patients (65%), partial response in 15 patients (33.5%) and
no response in I patient (1.5%). Forty patients from the placebo group completed the
study. Excellent response was achieved in 4 patients (10%), partial response in 20 (50%)
and no response in 16 patients (40%). The results were statistically significant.
Conclusions: we concluded that doxycycline was effective in the treatment of pityriasis rosea,
with very few adverse effects.

A promotion to a previous computer programmed technique "Photo-Micro Estimation Program" was
carried out to compute the exact dimensions of cell and cell fraction in photographs of
histological sections. "Visual Basic 6" was used as a language for building of the antecedent
application forms. With the aid of a slide micrometer, pixels were substituted for micrometer
(μm). The new procedure was termed "Photo-histometry program".
To test the suitability of this program, eight photographs of histological sections were selected
randomly to be tested. Results were contrasted with those calculated by using ocular lens
(calibrated by a slide micrometer).
Estimation of RBC diameter (well known, =7-8 μm) was the second step in assessing the
adequateness of this new program.
Results revealed that this program was simple, fast, adequate and accurate. It was better than the
calibrated ocular lens in being more precise (it enumerates up to the fractions of a micrometer)

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 chronic maxillary sinusitis.
Patients: Forty five chronic sinusitis patients were involved in the present study.
Methods: Sampling method were sinus specimens (aspiration or injection aspiration).
Results: Haemophilus species, Streptococcus pneumoniae (S.pneumoniae) and Moraxella
catarrhalis (M.catarrhalis) were the most frequent isolates; in addition Penicillium and
Cladosporium species were isolated from some chronic sinusitis patients.
Conclusion: Chronic sinusitis could be caused by either bacterial species or by fungal species;
most bacterial isolates were Haemophilus species followed by S.pneumoniae and
M.catarrhalis. The incidences of chronic sinusitis were more at patients age (20-29 years) old
groups

Seventy five adult virgin female Norway rats (60 experimental and 15 controls) were used to
evaluate the effect of seeds of three herbs (Fennel, Cumin and Garden cress) on their mammary
glands. Experimental animals were fed with these herbs (each type of herb seeds was given to twenty
experimental rats) for fourteen days. Rats were sacrificed and mammary gland sections were
obtained, stained then morphometrically assessed. Serum prolactin level was performed too.
Results revealed that Garden cress seeds are the strongest lactogenic agent among the three. Both
Fennel and Cumin seeds were shown to be very weak galactagogues.

Background: Aflatoxin B1 (AFB1) is a widely distributed mycotoxin in nature. Several investigations
have shown its biological effects on different organs and in different animal species. However, the
effects of AFB1 on the rat kidney have not been much elucidated histologically.
Objective: This study aims to demonstrate the effects of AFB1 contaminated diet on the rat kidney from
the histological and morphometric aspects.
Method: Twelve mature albino rats were divided equally into a control group fed with usual diet and a
treated group which was daily fed with diet contaminated with 20 mg AFB1/kg of body weight for 30
days. Semithin sections from renal cortex were stained with methylene blue and examined by light
microscopy. Corpuscular changes were also detected morphometrically in terms of the ratio between
the area of Bowman’s capsule and the area of its contained glomerulus (B/G ratio).
Results: The treated group showed a marked increase in body weight. Histologically, there was
evidence of acute tubular necrosis and increase in urinary space. Morphometrically, there was a
diffuse significant increase in the B/G ratio compared to the control.
Conclusion: Gain in weight can be attributed to fluid retention that accompanies the ensuing renal
damage. The dietary dose of AFB1 (20 mg/kg of body weight) for 30 days was sufficient to produce
acute tubular necrosis. The corpuscular changes indicated by the increase in the B/G ratio can be
attributed to compensatory hypertrophy.

Bagkground:Chlorpromazine is widely used in human medicine in the therapy of schizophrenia,
organic psychosis and the manic phase of manic depressive illness. It expressed a selective
cytotoxicity and the results of genotoxicity were positive.
Objectives: This study is designed to explore the effect of chlorpromazine on irradiated and non
irradiated calf thymus double strands DNA (ctdsDNA) molecule.
Methods: Aliquots of irradiated (subjected to UVB light) and non-radiated ctdsDNA samples
were incubatyed with different concentrations of chlorpromazine. Further series of experiments
studied the simultaneous effects of chlorpromazine and UVB light on aliquots of ctdsDNA, The
changes in optic densities of ctdsDNA aliquots were mointered and recorded bu UVspectrophotometer
at 260 nm.
Results: Chlorpromazine exerts dual effects on non-radiated ctdsDNA aliquots represented by
hyperchromasia and hypochromasia in regard to its concentration. It potentiates the effect of UVB
radiation on ctdsDNA molecules. Its effect is differed in respect to the radiation status.
Conclusion: chlorpromazine exerts several effects on aliquot ctdsDNA samples which are
related to the nature of DNA molecule as well as to the concentration of chlorpromazine.Also
chlorpromazine potentiates the hyperchromasic effect of UVB radiation on aliquot ctdsDNA
samples but it produces completely damage of DNA molecule when the aliquot ctdsDNA samples
irradiated in presence of chlorpromazine.

Background: Reports denote that changes in day length enhance or suppress components of
immune function in several mammalian species. The aim of present experimental study is
directed to test the hypothesis deals with the effect of photoperiods on some immune limbs
responsiveness.
Materials and Methods: Twenty six male and female BALB/C mice, 5-7 weeks old, 14-
18gm weight divided into two groups, test groups (n.=8 mice for each sex) and control
groups (n.=5 for each sex). Test groups were kept in a dark room for a month, while control
groups were kept in a room where the photoperiod was day light: darkness 12:12hr. All
studied groups immunized with o.2ml (10% sheep red blood cells) on day 4 and 8 of the last 12
days of the experiment. The weight of all animals were measured at the beginning and the
end of the experiment. Arthus reaction, delayed type hypersensitivity and serum antibody
titer were assessed on day 11 and 12 of program.
J Fac Med Baghdad
Vol. 49, No. 1, 2007
Received: May 2006
Accepted: Oct. 2006
Results: Significant increased (P<0.005) in body weight, index level of Arthus reaction,
delayed type hypersensitivity and serum antibody titer in the test groups in comparison with
the control groups.
Conclusion: Data are consistent with the hypothesis that immune parameters are enhanced in
short photoperiods or continuous darkness.
Keywords: Photoperiod, immune response