Journal of the Faculty of Medicine Baghdad

Background: -Gastrointestinal cutaneous fistula G.I.C.F. occur either postoperative or spontaneous, it is a major complication to patients & surgeons together,, still have significance incidence of morbidity’ & mortality.& it needs specific management.
Ainu-To study the causes of the fistula, to study the methods of treatment either medical or surgical with or without the use of total parenteral nutrition. T.P.N.
Patients& methods: -a prospective study done on 61 patients, divided into male &female, patients. G.I.C.F.were divided into high output & low output fistulae, then an attempt to find the causes of the fistulae & the type of treatment both conservative &surgical treatment, also to study the effect of the use of T.P.N.
Result:-45 patients were male &16 were female. Age range 13—58 years. The most common cause of the fistula M’as missile injury 39(63.93%)patients, followed by iatrogenic 6 (9.83%) then carcinoma of colon 6(9.83%).
59(96.72%) patients developed fistula postoperative, & only 2(3.27%) patients developed the fistula spontaneous. The most common site of the fistula M’as the ileum 22(30.06%) patients; the least common site M’as the esophagus 2(3.27%).
32 (52.45%) patients were with high output fistula. 29(47.54%) patients were with low output fistula. Spontaneous closure rate M’as 57.37%, total number of patients treated by conservative methods were39, while the total number of patients treated by surgery were22.
89.74% closure rate by conservative treatment, closure rate by surgical treatment were63.63%..The mortality rate M’as 12 (19.67%) patients.
Conclusion: -spontaneous closure rate of the fistula is high, the conservative treatment gave higher closure rate than the surgical treatment. The use of T.P.N.& octreotide decrease the morbidity & mortality.

Background: The healing of a sutured tendon in the hand usually occur with an unwanted amount of scarring that defeat good results. Many variables has been studied over many decades; timing of repair M’as a matter of debate. Zone II is the area where those variables mostly affect the results of treatment.
Objective: To study and evaluate the results of early or delayed repair under the effects of our local variables.
Method: Prospective study of 85 patients, which had flexor tendon repair at zone II by primary repair, delayed primary repair and tendon graft.
Results: Results showed a primary repair ended with better functional results than those with delayed repair and than those with tendon graft. Excellent & good results were 83.7% in the early repaired group versus 43.8% in the delaved groups; these results were statically significant; I’ 11.1)1)1)2.
Conclusion: We conclude that early suture is better than delayed suture and call on casualty doctors to refer patients to hand surgery unites to have better end results in this difficidt area of treatment.

Summary:
Background: CM is the leading cause of infant deaths and account for much greater proportion of infant mortality’ than does premature birth. A malformation is a primary structural defect arising from a localized error in morphogenesis. This is a prospective study devoted to define the causes and frequencies of congenital malformations (CM) in Maternal and Children Hospital (MCH) in Al-Anbar govemorate (west of Iraq) and a comparison is done with other Iraqi and international studies.
FdC Med Baghdad Methods: Congenital malformations were studied over a period of 2 years from the 1st of July 2000 2007/ Vol. 49, No.3 f0 fjle 30th ofJune 2002 in 12831 births including stillbirths at MCH in Al- Anbar govemorate (west Received July 2006 0f Iraq). A control group of 100 women who gave birth to normal newborn babies was studied Accepted Jan. 2007 similarly.
Results: The overall birth prevalence of CM is 8.5/1000 births (109/1283 1) and stillbirth prevalence is 21/1000 (269/1283 1) births. The most common system involved in CM is the CNS that constitute 55% of total CM followed by skeletal system 33% then GIT 7% urogenital 2% recognized syndromes 2%, and others 1 %.This study shows a significant association between each of stillbirth, LBW, polhydraminious,parental consanguinity advanced maternal age and family history of CM.The present study shows no significant association with each of urban /rural status, and sex, attending antenatal care, tonics, fever, UTI, and diabetes mellitus.
Conclusion: The overall birth prevalence of CM is almost the same as that recorded by Al-Saadoon et al in Basra which M’as 8.7/1000 in the year 1994 and lower than the birth prevalence of CM recorded by Grover-N in India in the year 2000 which M’as 17.8/1000 Associations between some of the risk factors and CM are similar and others are different from other studies.

Summary
Background Arteriovenous malformations (AVMs) of the brain are anomalies affecting different age groups of the population, and predisposing patients to significant neurological disability from stroke, epilepsy, or other clinical manifestations. Noninvasive modalities are revealing these lesions more frequently, and with more accuracy. Previous studies on Iraqi subjects with intracranial AVMs are scarce.
Objectives The aim of the study is to correlate the CT findings of intracranial ATMs with the clinical presentations, anatomic locations, the size, and the predictable origin of the arteries feeding these lesions and their venous drainage.
Patients and Methods The charts and CT scans offifty-four Iraqi patients with an AIM, 31 males and 23 females (male to female ratio 1.3: 1), ranging in age from 6-74 years (mean 37.7) who were seen at the Neurosurgical Hospital-Baghdad from October 1998 to August 2002 were reviewed.
Results Supratentorial AVMs were present in 53 patients; one patient had a left cerebellar AIM. The lesion was solitary, and directly localized in a single lobe, with more in the right lobes (mainly the parietal and temporal) in the non-haemorrhagic lesions, and in the left lobes of the AVMs presented with haemorrhage. The diameter of the lesion varied from less than 2.5 cm to >6.5 cm.
Conchision AIM may present symptomatically at any age .The arterial and venous components of the AIM could be explained by the site of the lesion. The size of the AIM could be evaluated as a potential factor predicting future AIM haemorrhage risk. Long-term follow-up evaluation is necessary for assessing the natural history and prognosis for such lesions.

Background: Nephrotic syndrome in children is a clinical manifestation of different histopathological subtypes.
Objectives: The objectives were to study the different histopathological subtypes of idiopathic nephrotic syndrome and to study their clinical and biochemical parameters at the time of diagnosis for children admitted to Children Welfare Teaching Hospital.
Methods: A Retrospective study M’as done on 160 children with idiopathic nephrotic syndrome who were diagnosed and/or treated at Children Welfare Teaching Hospital and were followed up in the pediatric nephrology consultation clinic betM\'een April 2004 and April 2006.
Results: The study group included 40 children with idiopathic nephrotic syndrome r Who underwent renal biopsy. There were 26(68.7%) males and 14(31.2%) females.
Age at onset ranged between (1-15) years, median age (3.5) years. Facial oedema M’as fcnmd in 90%, hypertension in 45% patients, gross hematuria in 27.5 and persistent microhematuria in 45%. Sixteen (40%) patients had focal and segmental glomemlosclerosis on renal biopsy, nine (22.5%) patients minimal change nephrotic syndrome, eight (20%) patients mesangioproliferative glomerulonephritis, and seven (17.5%) patients had membranoproliferative glomerulonephritis.
Conclusion: Focal and segmental glomemlosclerosis was the most common histopathological subtype in our study group. Further large studies is needed to find out changing trends of histopathology in childhood nephrotic syndrome
Key words: Nephrotic syndrome, Children, Histopahological subtypes

Background: Iraqi people have endured an excess burden of morbidity’ and mortality during the last two decades due to wars and sanctions. This report M’as carried out to assess the nutritional status of first year primary school children.
Methods: A total of3881 school children in Balad district in Salahadin govemorate was included in the study. Age, height and weight were recorded. Malnutrition was regarded as value of less than 2 SD of the reference value.
Results: Among the total sample, 16.5%, 20.06% and 15.3% were underweight, stunted and wasted, respectively. No significant difference was detected in malnutrition rates between both sexes. Conclusion: High rates of malnutrition were detected among school children.

Summary:
Background Mastalgia is described as diffused or itching pain of the breast. Usually, active movement of heavy breast supported by weak suspensory ligaments contribute mainly to the etiology of mastalgia which is considered the most frequent complaint of women attending Al-Elwiya teaching hospital for consultation.
Objective:- The aim was to minimiged breast pain in mastalgic women By wearing the sport brassieres with or without the Use of danazol
Patient and method :- Tow hundred and fifty cyclic and non cyclic women suffering
from some degrees of mastalgia were chosen randomly from breast clinic of AL-Elwiya teaching hospital from June 2004 till August 2005. The mastaligic women were divided into 3 groups: group A M’as prescribed to take 200 mg. danazol daily ,group B M’as instructed to wear the sport brassieresl while group C M’as prescribed to take 100 mg. danazol daily plus wearing the sport brassieres .The duration of the project M’as 12 weeks .All women under study were educated to complete a breast pain chart using visual analogue scale ,(VAS). Results: The outcome of the breast pain study revealed that ,the combined use of sport brassieres plus the intake of 100 mg.danazol associated with highly significant decrease in VAS with low side effects
Conclusion: The management of mastagic suffering women M’as the combined use of the sport brassieres beside the intake of 100 mg. danazol which decreased breast pain and minimized side effects

Background: Trichomonas vaginalis has long been recognized as a cause of infectious vaginitis in women different studies have demonstrated a significant burden of the parasite to cause urethritis as well. It has been assumed that the localization of parasite in the urethra may be responsible for the recurrence of vaginal infection.
Aim: To evaluate the infection rate of urethral trichomoniasis and to evaluate two different laboratory’ methods used in the diagnosis.
Methods: The present study consisted of420female patients presented with vaginal discharge with or without itching or disorient, investigated for urethral trichomoniasis who were compared to 50 females represented the control group.
Each female M’as asked to collect first 10-20 ml of urine in a sterile screw capped bottle; the deposits were examined microscopically by:
. Wet mount method for Trichomonas vaginalis.
2. Culture in a specific ready made culture media.
At the same time high vaginal swabs were taken and examined by both wet mount and culture methods for vaginal trichomoniasis.
Results: Among 420 female patients examined for both urine sediments and vaginal swabs ,80 (19.04%) females were found to be positive for T. vaginalis by vaginal SM'abs. The parasite was seen either in the vagina alone in 39 (9.28%) or in the vagina and urethra in 41(9.76%), but it M’as never isolated from urethra alone.
Conclusion: Trichomonas vaginalis is a common parasite offemale urethm as well as of the vagina, the localization of this flagellate in the urethra may be responsible for the recurrence of vaginal infection, since it may survive in the urethra, possibly in the Paraurethral glands (skene's) so when the treatment is limited to the vagina, this will often fail to reach the urethra and the trichomonads may contaminate the vagina following urination or sexual intercourse, that is why systemic rather than local treatment is indicated.

Background: The incidence of cancer of the cervix is comparatively low in Iraq, as in most other Islamic countries. Pre invasive lesions of the uterine cervix can be detected by Pap smears in their preclinical course, a fact which documents the significant role of cervical cytology in gynecological practice.
Objective: To emphasize the role of cervical cytopathology (Pap smears) in the detection and follow up of various cervical lesions that may predispose to cervical carcinoma with special emphasis on Cervical Intraepithelial Neoplastic (CIN) conditions or dysplasias.
Patients and Methods: This retrospective study M’as performed on 1500 women aged 20 years and above who attended the private clinical laboratory of the senior investigator during the period betM'een (May 2000 to May 2001). Cases were randomly selected. All relevant clinico-pathological data were recorded within a standardized interview report. After careful examination of the external genitalia, a Pap smear M’as obtained using Ayre's wooden spatula. Results were recorded and statistically analyzed.
Results: Cytological diagnosis revealed:
1065 cases (71.01%) of non specific cervicitis.
392 cases (26.13%) of specific cervicitis.
30 cases (2%) of cervical polyp.
172 cases (11.47%) of CIN! (mild dysplasia).
31 cases (2.07%) of CINj (moderate dysplasia).
10 cases (0.67%) ofCIN} (severe dysplasia).
According to the Bethesda system, atypical squamous cells of undetermined significance (ASCUS) M’as the most common epithelial cell abnormality representing (24.27%) of total group studied, while low grade squamous intraepithelial lesions (LGSIL) and atypical glandular cell of undetermined significance (AGUS) represented (13.27 %) and ( 16.2 %) of total group studied respectively. High grade squamous intraepithelial lesions (HSIL) were detected in (2.73 %) of the examined smears. Clinical examination revealed that the grades of CIN were higher in patients with older age groups and a statistically significant correlation M’as shown between parity and the severity of cervical lesions. Cervical erosions, hypertrophy and congestion were reported in a significant proportion of cases among our sudy population.
Conclusion: Pap smear cytology remains as one of the most effective tools used in the early detection and follow up of many gynecological disorders specifically precancerous lesions of the uterine cervix.. Cytological diagnosis of these lesions with treatment of the associated inflammations could be helpfid in preventing their progression into more serious cervical pathology.

Summary:
Background: Patients with facial pain without any overt disease especially of the nose and paranasal sinuses are often diagnosed as having Sluder's neuralgia. Large middle turbinates or septal deflections compressing the ethmoidal nerves have been regarded as one of the causes of this pain in those who have their sinus computed tomography (CT) clear.
Fac Med Baghdad Objectives: To evaluate the xylocaine test as a prognostic aid for surgical treatment for Sluder's 2007; Vol. 49, No.3 neuralgia.
Received Dec 2006 Methods: Sixty-one cases were seen; all of them had the xylocaine test positive. They were treated Accepted April 2007 surgically by endoscopic middle turbinectomy or septal surgery.
Results: All had relieffrom the symptoms 4 months post operatively, except in five cases relief M’as achieved after revision surgeries for intranasal synechiae.
Conclusion: The xylocaine (10 per cent) test seemed to be a good prognostic aid for the surgical procedures for those with Sluder's neuralgia when medical treatment did not seem to relieve the symptom.

Background: Benzene has been internationally recognized as a potent toxin, particularly for its effects on the blood forming system of the bone marrow and its association to a large number of haematological disorders.
Aims: This study aimed to assess the cytogenetic damages related to occupational exposure to benzene by calculating the mitotic index ( MI) , nuclear division cytotoxicity index ( NDCI), binucleated cells ratio and chromosomal aberrations.
Obgectives: Peripheral blood samples were collected from 30 benzene exposed workers and 10 from unexposed- controls- persons. 20 out of the exposed workers were occupationally exposed to benzene from 2 to more than 4 years. The rest of workers were exposed to benzene from one month to one year. Results: The mean MI in the benzene exposed workers ( 5.72 ± 0.62 ) M’as found significantly higher than in controls ( 4.03 ±0.37 ). The highest MI mean M’as calculated in the exposure group 4 to above vears.The NDCI of the exposure workers ( 3.38 ±0.54 )was also significantly higher than in control ( 2.04 ± 0.76 ).Lower NDCI mean was calculated in the 4 to above years exposure.
Conclusions: Chromosomal aberrations were observed in the exposed group. Polyploidy , anuploidy ( 5 monosomy and 9 trisomy ) and structural aberration ( del 8q ) were detected in the exposed groups 0-3 years.
MN frequencies were significantly increased in relation with length of employment. According to the KIN results and the chromosomal aberrations detected in the exposed groups, it could be possible that a correlation found between the elevated values of the KIN and the detected chromosomal aberrations.

Background: . Autoimmune hepatitis (AIH) is an unresolving inflammation of the liver of unknown cause associated with interface hepatitis on histological examination,hypergammaglobulinemia and presence of circulating autoantibodies. Antibody-mediated tissue injury might be responsible for tissue injury in AIH therefore; a number of studies have been focused on the complement system in these patients .
The aim of the study is to estimate the level of complement (C3 and C4) in different types of Autoimmune hepatitis (AIH).
Methods: The study M’as performed on 73 Iraqi patients with autoimmune hepatitis (AIH), attending the teaching hospital for gastroenterology and liver disease in a period betM'een November 2003 and July 2004. : Anti- soluble liver ANA , SAM,LKA1-1 ,and LC-1 Abs were detected using Enzyme-Linked Immunosorbent Assay (ELISA) technique . Anti-SLA/LP was detected using the Euroline method.
Quantitation of serum C3 and C4 of the study groups were carried by single radial immudiffusion (SRID) test. Equal volume
Results: Significant differences M’as observed between AIH patients and healthy control group in the mean level of C3 and C4. In addition, level of C4 in the sera of patients with type 2 was lower than those of type 1 and 3.
Conclusion:It M’as conclude that patients with MH do not have abnormal catabolism of complement or increased level of cleavage products of C3, whereas, the depression of complement level may reflect decreased hepatic synthesis.