Journal of the Faculty of Medicine Baghdad

Placenta accrete is defined as an abnormally adherent placenta that is directly attached to the myometrium because of inadequate development of the fibrinoid layer (Nitabuch layer) and absence of decidua basilis either partially or totally. (1) Three degrees of placenta accrete exist depending on the depth of villous invasion: placenta accreta is when villi become attached to myometrium, placenta increta: the villi invade the myometrium, placenta percreta represents the greatest degree of severity where placental villi penetrate throughout myometrium and peritoneum extending sometimes to adjacent structure such as the bladder. (1, 2, 3)Placenta accreta accounts for 78% of cases, increta for 17% and percreta 5-7 %.( 4)
Massive obstetric hemorrhage is still the leading cause of pregnancy related deaths, and placenta previa accreta remains one of the serious predisposing factors. (5)
The problem occurs when there is abnormal separation of placenta in 3rd stage of labor, and attempts to deliver the placenta may provoke massive blood loss that may necessitate hysterectomy. (2)
With the increasing rate of cesarean section the incidence of both placenta previa and placenta accreta is steadily increasing in frequency, (3, 4) we therefore anticipate more cases of placenta previa accreta.
In several recent series, placenta accreta has emerged as the major indication for peripartum hysterectomy, accounted for 40-60% of cases. (7),
It is not always clinically possible to differentiate between the three types of placenta accreta.Placenta accreta is not usually suspected when the placenta is normally situated, but antenatal diagnosis is possible when placenta accreta is previa. Accreta invasion may involve whole placental cotyledons, or partial (several cotyledons), or focal as one or two cotyledons.

Summary
Background: To find an operation that can be effectively carried out in both adults and children, equally applicable in the elective as well as in the emergency situation and for the good – risk as well as the poor – risk patients. Done by expert and junior surgeons in a short time.
Patients and Methods: Twenty patients with portal hypertension and bleeding varices aged 9-45 years were treated with shunting procedures (group 1, n=10), or a modified Sugiura operation (group 2, n=10) in accordance with the following therapeutic protocol: after resuscitation and diagnostic endoscopy, an emergency modified Sugiura operation was carried out if bleeding could not be controlled over 24 hours. When bleeding could be controlled, the patients underwent full investigation and were then treated with either shunting procedure or with a modified Sugiura operation. The Fisher exact probability test was applied for statistical analysis.
Results: Patients were evaluated at 1-3 years. The rates for operative deaths, recurrent hemorrhage, encephalopathy, late deaths, and patient survival at 1-3 years were as follows: 30%, 10%, 40%, 10% and 60% for group 1; 10%, 0%, 0%, 10%, and 80% for group 2, respectively. Within 3 months after the modified Sugiura operation, varices disappeared in most of the patients and hypersplenism was relieved in all.
Conclusion: We conclude that the modified Sugiura operation is probably a reasonable treatment for variceal hemorrhage because it is effective in arresting hemorrhage and it’s recurrence, with no encephalopathy, and a good survival rate.
Key Words: Portal hypertension, bleeding varices, non shunt operation, Sugiura operation.

Summary:
Background:Incisional hernia is frequently occurring post operative complication after general surgery with occurance rate 2%-----11%,, it is either appear soon after operation or late occurring incisional hernia..
Patient &methods: This is a prospective study that was conducted on 84 patients who were admitted at Baghdad Teaching Hospital during the period from Oct. 1999 to Aug. 2001 for repair of incisional hernias. Their ages were ranging from 24-74 years with mean age of (48 ±12). Sixty-nine patients were elective and 15 patients were urgent. Assessment of the patients for the predisposing factors influencing the development of incisional hernia was done and in our study these factors were: -
Results:.Wound infection in 66%, midline incision in 58.3%, obesity 55%, chronic obstructive pulmonary disease (COPD), with, respiratory tract infection (RTI) in 44%, multiparty with gynecological and obstetric procedures were 42.9%, diabetes mellitus (D.M) 28.9%, Old age in 21.4%, contaminated bowel surgery 21.4% & finally wound dehiscence with re-suturing in 7.1%. Simple repair was performed in 57 patients and prolene mesh repair was used for 27 patients and follow-up was continued for 6 months except for 8 patients who were lost from follow-up.
Results of simple repair was associated with many complications including recurrence in 4 patients, wound infection in 10 patients, seroma in 3 patients deep venous thrombosis (DVT) in one patient.
Whereas Mesh repair was followed with minimal complications of seroma in 3 patients and deep venous thrombosis (DVT) in one patient and no recurrence was recorded.
Conclusion: wound infection,,obesity,emergency surgery ,type of suture material & type of wound all areimportant factors leading to I.H.
Key word: incisional hernia causes,,simple or mesh repair.

Background: Frostbite is a cold weather injury characterized by tissue freezing. It can adversely impact military operations. This study was carried out to demonstrate the frostbite among Iraqi -Iranian war.
Materials: The over surveillance period was 1st Dec. 1987 to 1st March 1988. A form was tilled for each affected soldier. All cases were followed till Dec. 1988.
Results: The reported frostbite cases were 10 000 cases. The rate was of 100 cases per 100 000 person - year. The foot was the most affected site. High frostbite cases were reported during the active military operations.
Conclusion: Education, acclimatization and strict enforcement of cold weather injury preventive measures arc necessary in military services.
Key words: Frostbite, cold weather injury, army, Iraqi-Iranian war.

Background: Quantitation of serum immunoglobulins (IgG, IgA and IgM) provides useful information for the evaluation of certain cancers.
Objectives:to estimate serum immunoglobulins level before and after surgery, and to shed light on the correlation of immunoglobulins with progression of CRC.
Patients and Methodes. By single radial immune diffusion method IgG, IgA, IgM were estimated in 100 CRC patients preoperatively, and in 20 patients postoperatively compared with 35 patients control with ulcerative colitis (UC) and 50 healthy control.
Results: The study showed significantly increased the serum IgM level in patients group preoperatively (p<0.001) compared with control group. On the other hand, no significant differences were observed in respect to the mean of IgG, IgA, and IgM after surgical excision of the tumor in 20 patients.
Conclusion: These finding suggests that high level of IgM might be considered as prognostic indicator.
Keywords: serum immunoglobulins, Colorectal
cancer cases

Summary
Background : From the standpoint of mortality &morbidity, cancer is by far the most important clinical problem that concerns the breast today .The age adjusted incidence of new cases has been increasing steadily with increase in the incidence among the Iraqi women during the last few years .
Materials &method : A prospective study was arranged to assess the occurrence of post-surgical loco-regional recurrence of breast carcinoma in the Iraqi female patients , a total number of 91 female patients were assessed during period from Dec.2000 to Dec.2002, the median period of follow up was two years .
Result : Loco-regional recurrence developed in 20 patients (22%). Chest wall and axilla were the main sites of loco-regional recurrence seen in 12 (60%) and 6 (30%) patients respectively. Significant association were found regarding the duration between first complaint and surgical management (latency period), the size of primary tumour , the number of lymph nodes involved , staging , histopathology & grading of primary tumour .
While the association between the rate of loco-regional recurrence and age ,education level ,socioeconomic status ,contraception history, marital state , lactation state , family history , parity , type of adjuvant therapy, type of surgery were in-significant .
Conclusion: Carcinoma of the breast affecting Iraqi females at younger ages in a high & increasing rate than other studies with a higher Loco-regional recurrence rate. Significant association were found regarding latency period, staging, histopathology & grading of primary tumour .
Aims Of Study:
1. To assess the incidence of post operative loco regional recurrence of breast carcinoma in Iraqi female patients.
2. To determine the significance of certain variables that may affect the loco regional recurrence rate .
Keywords : breast cancer , locoregional , recurrence

Summary:
Background: This study comprises0two parts, the first one dealt with epidemiology, etiology and clinical picture of"brain abscess. This part describes diagnostic investigations, management and final outcome of brain abscess during a 10 years period.
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 3 1 " Dec. 2002, inclusive were reviewed. Data obtained included demographic and clinical data.
Results: Results of peripheral leukocytes count, ESR and CSF were supportive in 16.7%, 67.9% 78` o ol'cases in which tests were applied, respectively. CT scan was suggestive in 100% of cases. Use of antibiotic therapy as a preliminary treatment line was adopted in 37.8% of cases, while surgery as a preliminary line of treatment was adopted in 62.3% of cases. Out of 68 cases, complete resolution was encountered in 70.6°x% ol'cases, sequlae in 11.8% and death in 17.9%. Bad neurological 'status on admission was the most encountered contributing factor for death. Metastasis from a remote infection process is a risky aetiology contributing to bad prognosis.
Conclusion: The use Of C I Scan represents all important change in the diagnostic regimen of brain abscess in the last 10 -15 years.
__________________keywords:brainabscesses, Diagnostic
investigations

Summary:
Background: Diarrheal diseases are still a major public health problem especially in developing countries, due to their high morbidity & mortality rates, moreover the lagest number of deaths with diarrheal diseases are due to persistent diarrheal states.We attemted to evaluate the size of the problem in our infants, and assess risk factors & outcome.
Methods: A retrospective study was performed in Al-Kadhemya teaching hospital, to evaluate diarrheal cases in under 2 years of age children , admitted to hospital during the period (Dec. 1991- Dec. 2001), from a total of 863, chronic diarrheal cases formed 286 (33.14%) that were evaluated for certain variables; epidemiology & risk factors etiology ,complications and the final outcome .
Results & Conclusion:We concluded that: chronic diarrhea formed more than 33% of admitted diarrheal cases to the hospital, of the important risk factors for diarrhea both acute & chronic types were bottle feeding , young age. Lactose intolerance,parasitic infestations and UTI were the common etiologies. Malnutrition was common in cases of chronic diarrhea together with multiple clincal and lab derrangements.The mortality rate was -4%.
Key words: chronic diarrhea, risk factors, etiology, complications, mortality.

Summary:
Background: Total serum sialic acid (TSA) and lipid associated sialic acid (LSA) have not been measured yet in depressive disorders.
Aim :The present study was undertaken to show if there is any change in the concentration of different forms of sialic acids in patients with depressive disorder.
Methods: TSA and LSA levels have been estimated in serum of 72 patients with depression, in addition to 50 healthy controls .
Results reflect a significant increase (p<0.05) in the TSA and BSA in the depressed patients as compared with healthy controls.
Conclusions: It could be concluded that TSA and BSA could reflect an immune like response to depression associated with increase in the sialylation of different glycoproteins.
Key Words: Serum Total Sialic acid , Depression , Free Sialic acid , Bound Sialic acid , Lipid Associated Sialic acid.

Summary:
Background: Antiphospholipid syndrome (APS) is a disorder in which vascular thrombosis and / or recurrent pregnancy losses occur in a patient who has laboratory evidence of antibodies against phospholipids or phospholipids binding protein cofactor. Usually the patient presents at an age between 35-45 years, with equal male to female ratio. Mostly they present with thrombosis or pregnancy complication. A quarter of the patients have thrombocytopenia and about one fifth have hemolytic anemia. The diagnosis rests on the criteria set as the Revised classification criteria for the Antiphospholipid syndrome
Patients and Methods; During the period from 1st Jan. 2002 until the 1st Jan. 2006,24 patients who met the criteria of APS (according to Revised classification criteria for the Antiphospholipid syndrome) were included in the study.
The diagnosis of deep venous thrombosis (DVT) was done by using Doppler study of the selected organ, while brain CT and magnetic resonance imaging were used to diagnose cerebrovascular thromboses.Serological evidence of APA were either an abnormal KCT and KCT index and/or a positive aCL antibody test on 2 occasions.
Results : Three quarter of our patients were females, more than half of them aged 21-30 years ,54.16% of our patients presented with thrombosis the commonest site of which was DVT of lower extremities. Abortion alone was the presenting problem in two patients and two patients presented with thrombosis following abortion Another two patients presented with bleeding problems. Gathering the history; follow up abortion occurred in ten of the thirteen premenapausal married ladies, of whom five had more than three abortions.Laboratory evaluation revealed anemia in 8 patients (33.33% ) and thrombocytopenia in 5 patients (20.8% ).The KCT and KCT index were suggestive of APS in 14 of the 23 patients tested (60.86%)and the aCL was positive in 15 of the 19 tested patients (78.94 %).
Conclusion, We think that our study, although small, highlights some of the clinical and laboratory findings of this syndrome in Iraqi patients, larger studies are needed for better evaluation..
Key Words: Antiphospholipid syndrome (APL), anticardiolipin antibodies(aCL).

Summary:
Background: Acute inflammatory demylinating polyneuropathy (Guillain-Barr'e syndrome) is the commonest cause of acute neuromuscular paralysis in most countries. The onset of symptoms in patients with GBS can either be acute or sub acute .Ventilatory failure is primarily caused by inspiratory muscles weakness although weakness of abdominal and accessory muscles of respiration, retained airway secretion leading to aspiration and atelectasis are all contributing factors. Nutritional support of critically sick children is important for metabolic maintenance and tissue repair.
Methods: To identify clinical and respiratory features associated with progression to respiratory failure in children with GBS. Twenty two consecutive children with severe (Rapidly progressive) GBS admitted to the RICU in Children Welfare Teaching Hospital-Medical City –Baghdad, between July 2004-July 2006, were studied .Other 22 children with sub acute GBS who didn't receive mechanical ventilation admitted in the same period to the same hospital as a control group.
Results: There is significant association between each of bulbar, autonomic neuropathies and low SiO2 at admission with severe GBS .There is significant reduction in duration of mechanical ventilation and duration of RICU stay achieved by the use of Freamine amninoacid solution as partial parenteral nutrition.
Conclusion: Progression to mechanical ventilation was highly likely to occur in those patients with rapid disease progress (less than one week) bulbar dysfunction and dysautonomia, and low SiO2 at admission. Partial parenteral nutrition may reduce the duration of mechanical ventilation and RICU stay by about 3 days.
Keywords: GBS; mechanical ventilation; children.

Summary:
Background:To evaluate the accuracy of serum uric acid to predict maternal and fetal complications in women with pre- eclampsia.
Design: Prospective study. Setting: Tikrit Teaching Hospital.
Subject and Methods: Fifty normotensive and forty-three pre-eclamptic pregnant women at (20-24) weeks of gestation were the study subject, serum concentrations of uric acid were measured and examine the correlations between serum uric acid level with fetal and maternal complications.
Result: Serum concentration of uric acid in pre-eclamptic women were significantly higher than in gestational age match normotensive pregnant women, and women with pre-eclampsia and elevated uric acid concentration at increased risk of low birth weight , preterm delivery and cesarean , delivery compared with each condition in absence of hyperuricemia.
Conclusion: Hypervricemia consider a good predictor to select group of per-eclamptic women with high risk for fetal and maternal complications.

Summary:
Back ground: Oxidative damage has been suggested to play a key role in accelerating inflammation and to be involved in the pathogenesis of rheumatoid arthritis (RA) and osteoarthritis (OA). Many studies had shown that those patients have low antioxidants level and are at risk of increased oxidative stress.
Objective: This study was designed to examine the levels of serum Total Antioxidant Status (TAS). Malondialdehyde (MDA) as index of lipid peroxidation and C–Reactive Protein (CRP) as a marker of oxidative stress in patients with RA and OA and compared them with healthy control.
Method: Serum TAS , MDA and CRP levels were measured in 16 RA and 24 OA patients and compare with those obtained from 25 healthy controls.
Results: Serum TAS were significantly lower in RA group than in the OA and control groups (P < 0.05). Serum MDA and CRP levels were significantly higher in patients with RA than in those with OA and healthy subjects (P< 0.05). There were significant negative correlations between TAS and MDA, CRP levels (r = -0.850; p < 0.001) and ( r = -0.498; P < 0.05) respectively and a positive correlation between MDA and CRP levels in the RA group (r = 0.686; P < 0.01) .
In OA group, the level of CRP was significantly increased (P< 0.05) and there was significant positive correlation between age and MDA level (r = 0.553; P < 0.01).
Conclusion: Our results demonstrated that levels of lipid peroxidation are increased in patients with RA compared to controls and patients with OA , In addition serum TAS levels were decreased in RA. Serum TAS levels may be used as a routine and rapid test to verify the levels of oxidative stress in RA. Furthermore correlating TAS and MDA levels with a cute phase reactants such as CRP may give some clues about disease activity in RA .

Keywords: Oxidative Stress, C – Reactive Protein, arthritis

Summary:
Background : The new biological marker, ischemia modified albumin (IMA) measured by albumin cobalt binding (ACB) test was introduced for the detection of myocardial ischemia.
Objective The aim of the present study was to describe the performance characteristics of the ACB test in suspected acute coronary syndrome patients who presented to the emergency department early after the onset of ischemic events and to verify the specificity of the test for myocardial infarction .
Subjects and methods: Forty five patients presented to the emergency department (ED) with chest pain and 31 healthy controls were involved in the study. Serum albumin and ACB test were performed on all subjects, while serum CK-MB was done on patients with chest pain only.
The patients were diagnosed to have either myocardial infarction, MI (30) or unstable angina, UA ( 15 ). The sensitivity and specificity of the ACB test for the detection of ischemia were evaluated by ROC curve analysis.
Results and conclusion ACB test could be considered as an early test for myocardial ischemia and could detect ischemia much earlier than other cardiac markers. The significant negative predictive value of the test may play an important role in the rapid rule out of myocardial ischemia and will reduce the inappropriate admission of low risk patients. However it is a poor discriminator between patients with MI and those with UA.
Key words : Albumin Cobalt binding test , myocardial ischemia unstable angina.

Summary:
Background: Chronic atrophic gastritis is a precancerous lesion. A commonly used test for the diagnosis of chronic atrophic gastritis, gastric endoscopy with biopsy collection, and a good serological test would be best include low levels of pepsinogen I (PGI) or a low PGI/PGII ratio.
Aim of the study: To confirm the use of serum pepsinogens as a screening marker in atrophic gastritis.
Patients and Methods: A study was conducted in the period between December 2005 and March 2006 on 25 patients with atrophic gastritis attending Gastroenterology and Hepatology Teaching Hospital in Baghdad, and 25 healthy control subjects. Sera were tested for PGI and PGII by ELISA test.
Results and Conclusions: the serum PGI were decreased significantly with atrophic gastritis and the PGI/PGII ratio were decreased in (78%) of patient group and not affected in healthy people.
Key Words: PGI, PGII and Chronic atrophic gastritis.

Summary:
Background: Human leukocyte antigen (HLA) is the most polymorphic genetic system in man. The genes of this region influence susceptibility to certain disease.
Objectives: This study was established to shed light on the possible association of HLA class I and II antigens with RV patients.
Patients and Methods: Lymphocytotoxicity assay for HLA for class I and II typing had been done for (100) Iraqi patients suffering from rheumatic valvulitis (RV), the control groups consisting of (75 healthy individuals and 35 non rheumatic heart disease (NRHD) patients ).
Results: The results showed a significant association of A33-Ags with these patients as compared with healthy and cardiac controls (P=0.005), (P=0.033) respectively. Another interesting finding was the low frequency of A1 in RV patients when compared with healthy control (p=0.002), suggesting that A1 allele may confer protective effect against this disease. In addition significant association between blood group B and RV was evident (p=0.04). An interesting observation was a strong association of blood group B and A33 among those patients (P<0.001).
Conclusion: The present results are consistent with hypothesis that susceptibility to RV is genetically linked and in turn may be associated mainly with A33 in Iraqi patients.
Key words: HLA, rheumatic valvulitis

Summary:
Background: Autoantibodies are frequently found in patients with chronic hepatitis C, which suggests that HCV elicit an immune response in the host. ). The relationship of type-2 AIH to chronic hepatitis C (HCV) is an interesting and as yet unresolved problem. Importantly, antibodies to liver/kidney microsome type-1 (LKM1), the serologic marker of type 2-AIH, have been recognized in serum of some patients with chronic hepatitis C .
Methods: Anti-liver kidney microsome type 1 (LKM-1) autoantibodies were studied by indirect immuno florescence assay (IIF) and confirmed by immunoblot in the serum of 73 Iraqi patients with autoimmune hepatitis (AIH) in comparison with 50 patients control (HCV infection) and 50 healthy individuals.
Results: anti-LKM 1 with high titers (1/160) present in serum of all patients with AIH-2, whereas they present in titer (≤1/80) in serum of 19 patients with chronic HCV, while all healthy control group are negative.
Conclusion: AIH is easily distinguished from chronic viral hepatitis since patients with AIH are more commonly women than those with chronic viral hepatitis, and they have higher serum levels of aspartate aminotransferase, bilirubin, gamma-globulin, IgG, alkaline phosphates, and higher frequency of multilobular necrosis on histologic examination than counters with chronic viral hepatitis.

Keywords: HCV, AIH, , IgG

Summary:
Background: Rheumatoid Arthritis (RA) is an autoimmune disease. Many etiological agents are proposed to play a role in its pathogenecity. One of these factors is cytokines such as Interleukin¬6. Material & Methods: ELISA method has been used for IL-6 estimation in 75 RA patients in comparison with 61 SLE as patient controls and 39 apparently healthy controls.
Results: This study showed that there was an elevation of IL-6 in the sera of RA patients with high significant differences between RA patients and controls (P< 0.001). Moreover a good correlation between IL-6 level & RF titer were observed. However, for most patients with high IL-6 were shown to be HLA-DR4.
Conclusions: Interleukin-6 play a crucial role in the disease which may be participate in the severity of RA & subsequently its treatment.
Key words: RA, IL-6, RF, HLA-DR4, ELISA, Microlymphocytotoxicity

Summary:
Background : Bronchogenic carcinoma is a common malignancy in iraq and radiotherapy is one of treatment methods for this disease . This study is cytopathological study dealing with sputum samples for bronchogenic carcinoma before and after radiotherapy .
Objectives : To find morphological changes of the malignant cells as seen in cytopathological examination of the sputum after radiotherapy to the chest .
Patients and Methods : Twenty five patients with a recent diagnosis of bronchogenic carcinoma presented to the Institute of Radiotherapy and Nuclear Medicine for the treatment in the period between 20th july 2004 and 25th june 2005 , sputum samples were obtained from these patients before and after they received radiation therapy to the chest (850 rad from cobalt 60 machine) .The malignant cells were studied by light microscope , cytological features of the malignant cells are compared before and after irradiation . Chi square test and P value were used as statistical methods for comparison of the changes in the malignant cells .
Results : Squamous cell carcinoma was the most common type in this study. Cytoplasmic vacuolations in the malignant cells after radiation were not significant ( p value>0.05),nuclear changes following irradiation were significant (p value<0.05) .
Conclusion : malignant cells are affected by radiation with cytoplasmic and nuclear changes .
Key Words : Cytomorphological changes ,Bronchogenic carcinoma , radiation

Summary:
Background: Idiopathic thrombocytopenic purpura , a disorder characterized by auto¬antibody mediated platelets destruction causing decreased number of circulating platelets manifest as bleeding tendency. Since the discovery of Helicobacter pylori (H. pylori ) several studies have been published concerning a hypothetical role of this bacteria in idiopathic thrombocytopenic purpura.
Aim of the study: Evaluate the pathogenic correlation between H.pylori infection and idiopathic thrombocytopenic purpura.
Patients and Method: A cross sectional study was done on 30 cases of idiopathic thrombocytopenic purpura admitted to the Pediatric Hemato-Oncology unit in AL¬Kadhimiyia Teaching Hospital and 20 cases of sex and age matched healthy children as a control to determine the relation between H. pylori infection and idiopathic thrombocytopenic purpura. The peak age for idiopathic thrombocytopenic purpura was between ( 6-10 years) of age, (43.33%) . Male : female ratio equal to 2:1 . ELIZA test was used to measure the serum IgG antibody titer against H. pylori , 5 cases of idiopathic thrombocytopenic purpura was found to be positive for H.pylori (16.67%)while the test was negative in all of the control group (100%) ,
Results: a result which is statistically highly significant, p - value<0.05. Of the positive cases 3 (60%) was chronic idiopathic thrombocytopenic purpura and two cases (40%) was acute idiopathic thrombocytopenic purpura. Patients with positive test were older than those with negative test. The mean platelet count was less in the positive than those with negative test. A weak inverse correlation was found between platelet count and H.pylori serum antibody titer( r- value equal to -0.13437). The test was sensitive in (20%) and specific in (100%) of cases.
Conclusion: H. pylori infection may play a role in the initiation of idiopathic thrombocytopenic purpura and eradication of H.pylori infection can cure idiopathic thrombocytopenic purpura specially in chronic and resistant cases. The ELIZA test can be used as a screening test to detect H.pylori infection in children with idiopathic thrombocytopenic purpura.
Key word: Helicobacter pylori infection, idiopathic thrombocytopenic Purpura

Summary:
Background: Urine cytology has an acceptable sensitivity, & specificity that justifies its use in the current diagnostic protocol.
In Iraq transitional cell carcinoma (TCC) constitute about 62.1 % of bladder cancer (which ranks the third according to the results of Iraqi Cancer Registry 1995-1997). Urine cytology used in the primary
diagnosis, follow up, and in the screening programs of asymptomatic but high-risk patients.
Patients and methods: This study was conducted on 93 patients, diagnosed or clinically suspected to have TCC of the urinary bladder attending to the Urological department in AL- Kadhimiya Teaching Hospital, AL-Yarmouk Teaching Hospital, and Baghdad Medical City. During the period from July 2004to July 2005. 76 were males & 17 were females.
Urine cytological examination was done to those patients using two types of stain (hematoxylin and eosin, and papanicoloau stain) to detect malignant cells with the identification of the degree of differentiation, if possible, the cytological findings were correlated with the histopathological findings. And the cytological findings compared regarding each type of stain.
Results:. Mean age of the patients was 59 year. Male:female ratio was 4.4:1. Main clinical presentation was hematuria (45.8%) of the total.
Urine cytological examination has a sensitivity of 87.7%, specificity of 100% with an overall accuracy of 78% in the detection of TCC of urinary bladder. The main chief complaint of patients with TCC was haematuriawitch constitute 45.8% of the total. The percentage of high¬grade cases in urine cytology was higher than that in histopathology.the percentage of cases of TCC diagnosed by papanicoloau stain was more than that diagnosed by H & E (73.24% by pap stain versus 70.42% by H&E).
Conclusion: Urine cytology has an acceptable sensitivity, specificity and an overall accuracy in the diagnosis of TCC of urinary bladder, and it offers a good chance for determination of the grade of the tumor especially in high grade tumor. Pap stain was better in the diagnosis of TCC.
Keywords: Urine cytology, bladder cancer,

Summary:
Background: Hydatid cyst disease is a parasitic zoonotic disease caused by genus Echinococcus. This disease believed to has genetic background in it's aetiopathogenesis course .
The aim of this study is to shed light on the possible correlation between HLA-class I (A,B,C) & HLA-class II (DR & DQ) antigens and the susceptibility to this disease.
Patients & Methods: Fifty patient with hydatid cyst disease before undergoing surgical operation were investigated for HLA. Class I and class II by using microlymphocytotoxicity test. The results were compared with 115 healthy control.
Results: Significant increased trend of HLA-A28 and A-11, -B18 and B-35, -DR3 and DR-11 (P<0.001, P<0.01) in patients with this disease as compared with healthy control. On the other hand, increased trend of HLA-28 (P<0.01) in patients with hydatid disease especially in those with a cyst location in liver.
Conclusions: High frequency of HLA-A11 and –A28, B18 and –B35, -DR3 and –DR11 antigens may play major role in susceptibility to hydatid disease. HLA-A28 could be the most related antigen to this disease and acting as genetic marker that could in one way or another play crucial role in susceptibility especially in cases of hydatid disease in liver.
Keywords: Hydatid cyst disease, HLA-typing

Summary:
Back ground: Psoriasis is a chronic relapsing disorder with no life long cure, many systemic and topical modalities are available, one of these topical modalities is the vitamin D analogue (calcipotriene) which is widely used recently to treat psoriasis and many other skin problems.
Aim of the study: Is to compare the safety, the efficacy and the tolerability of tolerability of topical calcipotriene, topical clobetasol and both of them in combination in treating Iraqi patients with psoriasis vulgaris. (The first study in Iraq that uses calcipotriene ointment in treating psoriasis and comparing it with other known topical treatments that were commonly used to treat this problem).
Patients and methods A total of 128 patients with stable plaque psoriasis (72 males and 56 females) with ages between 13 and 68 years and a mean age of 36 years were included in this study, the patients put in four groups: the first one was treated with calcipotriene ointment only, the second was treated with clobetasol ointment only, the third was treated with both drugs in combination and the fourth was treated with Vaseline ointment as placebo. The patients were fully assessed clinically before, during and after the treatment.
Results: The study showed that the combination therapy was more effective than calcipotriene or clobetasol alone as it significantly reduced the mean percentage of PASI score within two weeks of treatment
(in 55.9 %, 42.5% and 31.9% of the patients respectively) , the study also showed that the combination therapy had a significantly faster response and a slower relapse rate than that of each drug alone and the effect of calcipotriene appeared to be faster in patients who had no previous treatments.
Conclusion:Calcipotriene ointment is a relatively safe, a moderately effective and a well tolerated drug, however, its combination with
a potent (very potent) topical corticosteroid will lead to better therapeutic results than the use of each one of them alone.
Keywords: Topical application of Calcipotriene, Psoriasis Vulgaris

Summary:
Background: Trichomonas vaginalis is a common parasite of both male and female genital tracts. Transmission of the infection is mainly by sexual intercourse; however contaminated towels, douche equipments, examination instruments and other objects may be responsible for some infections.
Aim: Is to study the influence of some factors that affect the spread of this parasite such as socioeconomic status, marital status, pregnancy and parity …….etc.
Methods: The study was conducted in the period from November 1992 to August 1993 on 480 female patients presented with vaginal discharge with or without itching, compared to 50 females complaining of gynecological problems other than infections.
Investigations carried out during this study include:
.Wet mount examination.,.Culture on artificial media.,Examination of fixed stained smear with:
a.Gram's stain.
b.Leischman's stain.
c.Giemsa's stain.
d.Papanicolaou's stained smear.
4. Measuring the PH of the vaginal discharge or the PH of the vaginal side wall.
Results: The effect of some factors on the prevalence and pathology of Trichomonas vaginalis was evaluated in this study. Among different socioeconomic groups, the higher infection rate (65.22%) was seen in the low socioeconomic group. The infection rate of trichomoniasis was found to be higher among married females (19.81%), than divorced (16.66%), widowed (12.5%) or singles (11.11%). Regarding the menstrual cycle, infection with Trichomonas vaginalis was found to be increasing during the postmenstrual phase of the cycle (24.21%) compared to the infection rate obtained from patients in the premenstrual phase of the cycle (16.09%). A higher infection rate was reported among non pregnant females (20%) than pregnant (9.09%).Females using different contraceptive measures showed an infection rate of (28.88%), which was higher than that reported among those not using any contraceptive measures (18.95%). The PH values of the vaginal discharge were measured in 90 patients and the highest infection were seen at PH values 6.0 (28.88%) and 5.5 (20%) respectively.
Conclusion: The spread of Trichomonas vaginalis infection may be affected by many factors such as socioeconomic status, marital status, pregnancy status and parity, phase of the menstrual cycle, the use of different contraceptive measures and the PH values of the vaginal discharge..
Key words: Epidemiology of Trichomonas vaginalis. Trichomoniasis.

Summary:
Background: To determine the DNA content in subfertile patients and correlate it with seminal sperm parameters, (count, motility and morphology).
Design: Prospective observational study.
Setting: College of Medicine, Department of physiological chemistry and Institute for Embryo research and Infertility treatment, University of Baghdad.
Methods: A random sample of 58 subfertile male patients undergoing semen evaluation and their age ranged from 20-45 years were studied. Semen samples were assessed for seminal sperms (count , motility and morphology) by direct light microscopy. Sperm DNA content was estimated using a microchemical spectrophotometric method .The data were categorized into four groups according to normal and abnormal sperms count ( million / ml ),percent motility and percent morphology. The normal limits of those sperm function parameters were according to WHO criteria. The four groups were named as Normozoospermic (NZS) (control) , Normoasthenozoospermic (NAZS) ,Normoasthenoteratozoospermic (NATZS) and oligoasthenoteratozoospermic (OATZS) groups.
Results: The Mean ± SD of the four groups were of significant difference (P> 0.05 ) with respect to sperm count, sperm percent motility and morphology with exceptions of certain groups. Moreover, a non significant difference (P< 0.05) was found with respect to DNA content (µg /ml) and (µg/sperm) except for Gr. IV which showed a significant difference when compared to others.The correlation coefficients (r values) between sperm count and sperms motility, morphology and DNA content (µg/ml) were non significant in the four groups. Noticeably, the DNA content (µg/sperm) was statistically of significant (P>0.05) negative correlation with sperm count in all groups.
Conclusion: All groups were of significant difference (P<0.05) among their Mean ±SD values of their count, motility and morphology. There were few exceptions. No significant differences (P>0.05) were found with respect to DNA content (µg/ml or µg/sperm) except for oligoasthenoteratozoospermic group compared to others. No significant correlation was found between sperm count and each of sperms motility , morphology and DNA content (µg/ml) in the four groups .However, the DNA content (µg/sperm) had a statistically significant (P<0.05) negative correlation with sperm count in all groups.
Keywords:DNA, sperm concentration(count million/ml ), Normozoospermic(NZS),Normoasthenoszoopermic(NAZS),Normoasthenoteratozoospermic(NATZS), Oligoasthenoteratozoospermic (OATZS ) .

Summery
Back ground Otitis externa (OE) is an inflammation of ear canal between ear drum and the outside of the ear.
The aims of the study to isolate and identify the causes of otitis externa, to determine the antimicrobial susceptibility pattern, to detect the seasonal distribution of the OE patient.
Material and patient Fifty ear swabs were collected from suspected cases of OE over one year from January to December 2005 in Al-Kindy Hospital. The ratio of male to female was 1.7-1, and the most common ear infection was (40%) of males at age group (10-19) years. Ear swabs were collected and inoculated to blood and maCconkey agar. Morphological identification and biochemical tests for growing bacteria were done. Antimicrobial susceptibility test was carried out.
Results This study showed out of 50 ear swabs, 12 swabs (24%) showed no growth while 38 swabs (76%) showed the growth of bacteria, the most common bacteria isolated was Pseudomonas aeruginosa (36%) followed by Proteus mirabilis and Staphylococcus aureus (18%) each and Enterobacter aerogenes (4%). Amikacin was effective antimicrobial agent against P. aeruginosa (61.1%) and Proteus mirabilis (66.6%), while chloramphenicol was effective agent against P. mirabilis (66.6%), S. aureus showed susceptibility to bactrim (septrim), erythromycin, clindamycin (55.5%) each followed by ciprofloxacin (33.3%), while E. aerogenes showed susceptibility to ciprofloxacin (100%). This study showed that P. aeruginosa, E. aerogenes and S. aureus resistant to cefixime, ceftazidime, chloramphenicol. Finally the study showed that 60% of OE was during summer and the least infection was during winter (4%).
Conclusions Pseudomonas aeruginosa was the most common bacterial isolates. There is no specific antimicrobial agent against pathogenic bacteria.
Keywords: Pseudomonas aeruginosa,, antimicrobial agents