Journal of the Faculty of Medicine Baghdad

Background: Retinoblastoma is the most common intraocular tumor affecting young children.
Objectives: To review the clinical presentation and treatment outcome of retinoblastoma in children treated at the Children Welfare Teaching Hospital, Baghdad.
Patients and Methods: A review of 32 children with retinoblastoma, diagnosed and treated at the Oncology Unit, Children Welfare Teaching Hospital, Medical City, Baghdad from 1999 to 2006.
Results: Among 32 patients, 56.25% were males and 43.75% were females with a median age of 34.5 months. Unilateral disease was observed in 19 patients. Leukocoria was the most common presenting feature. Advanced stages were predominant in half of the patients. Chemotherapy following eye enucleation was the mainstay of treatment. The disease-free survival was 23.33% while the mortality rate was 26.67%.
Conclusions: This single center study reported a poor outcome and a low disease-free survival due to high frequency of advanced stages and abandoning treatment by the parents.

Background: Cerebrospinal fluid leak is a relatively common problem ranging from 0.5% to 18% with traumatic or incidental injury to the Dura intra-operatively1, 2. Traumatic injury mostly occurs due to mechanical trauma with subsequent thecal sac laceration mainly in the thoracolumbar region. Incidental Dural injury commonly happens in patients undergoing spinal surgery for any reason.
Objective: Introduce a maneuver to be used during operations when the patients have either traumatic or iatrogenic injury to the Dura which would prevent CSF leak post-operatively.
Method: A case series study conducted in Baghdad, medical city, between June 2014 and March 2018 on 250 patients (45 females and 205 males) who had either traumatic or iatrogenic injury to the Dura. The operative technique introduced by Perry was used as a reference1. The maneuver used in this study to manage CSF leak intra-operatively described here in this study for comparison with other articles.
Results: In this study 250 cases out of 2500 spinal surgery cases, were diagnosed intra-operatively to have Dural injury either post-traumatic or incidentally during surgery. Dural injury occurred in 70 electively operated cases either incidentally or in cases of Dural exploration for different spine pathologies, of whom 13 patients (5.2%) had spinal surgery at the same site previously.
Conclusions: Proper identification of intraoperative CSF leak is crucial for prevention of post-operative complications. CSF leakage can be prevented by applying and reinforcing all surgical field layers with watertight sutures.

Background: The occurrence of incidental thyroid cancer (ITC) has increased by three times during the last decades and this rise could be attributed to many factors. To limit the prevalence of ITC with goiter especially nodular goiter, total thyroidectomy can become a procedure of choice.
Objective: To determine the extent of incidental thyroid carcinoma (ITC) and to plan a proper preoperative diagnostic work up and a convenient operative procedure for patients with different thyroid diseases.
Material and Methods: A prospective study was conducted during the period from October 2013 to October 2016 at Baghdad teaching hospital (main tertiary hospital in Iraq), first surgical unit by a single surgeon and his trainees. The study included 473 patients who were referred for surgical treatment of different thyroid diseases. About 71 patients were excluded from the study due to the diagnosis of malignancy (MNG) by FNAC or history of surgery. The remaining 402 patients were evaluated for the presence of the cancer by post-operative pathological examination.
Results: ITC was found in 77 patients (19.15%). While, 63 patients with non-toxic MNG (15.6%), 12 patients with non-toxic solitary thyroid nodule (3%) and two patients (0.5%) with toxic MNG were observed in the study. Out of 77 patients with ITC, 56(72.7%) were ˂45 years and the remaining 21 (27.3%) ≥45 years. The 15 patients were males and 62 patients were females in these groups.
Conclusions: Although ITC in this study is relatively high especially in MNG; a more radical surgical treatment seems needed in the management of patients with presumably benign thyroid disease. The authors identify a potential benefit in performing total thyroidectomy instead of near or subtotal when considering management of MNG.

Background: Many thymoma classifications have been followed and have been updated by newer or alternative schemes. Many classifications were based on the morphology and histogenesis of normal thymus as the backbone, while other classifications have followed a more simplified scheme, whereby thymomas were grouped based on biological behaviour. The WHO classification is currently the advocated one, which is based on “organotypical” features (i.e. histological characteristics mimicking those observed in the normal thymus) including cytoarchitecture (encapsulation and a “lobular architecture”) and the cellular composition, mostly the nuclear morphology is generally appreciated.
Objectives: This study aims to re-classify thymomas by establishing certain morphometric parameters to evaluate the epithelial cells nuclei. An appraisal of thymoma classification as cortical/ lymphocytic/ type B1 and B2 or medullary/ spindle cells/ type A will be attempted as objective re-evaluation of thymoma.
Patients: This study is a retrospective evaluation of 50 cases of thymoma, 20 cases of thymic hyperplasia and 10 cases of normal thymus (control group). Using a 5 μm formalin-fixed paraffin embeded tissue sections, stained with hematoxylin-eosin stain, these cases were previously classified histologically into lymphocytic (6 cases), lymphoepithelial (mixed) (28 cases) and epithelial (16 cases), including 2 cases of spindle cell thymoma.
Methods: Computer-assisted morphometry was performed for 80 cases. This involves digitization of the histopathological features and application of morphometric analysis through software. The morphometric parameters used are nuclear area, maximum nuclear diameter and Form factor of epithelial cells nuclei. Ten normal thymus glands from the archived cases were also evaluated as a control groups.
Results: The results showed that epithelial thymomas possess significantly different nuclear areas from that of a normal thymus, the maximum nuclear diameter (D-Max) follows the same pattern and adds no further outcomes. The numerical morphometric analysis showed no significant differences between lymphocytic predominant thymoma and those classified as cortical thymoma (Type B2). Thus it does not support such a re-classification. Form factor is an indication of pleomorphism, but it should be cautiously used when spindle cells are present since it may give a false indication of pleomorphism.
Conclusion: Computer-Assisted morphometric analysis provides an objective, reproducible and comparable results for thymoma histological classification.

Background: Bronchiolitis is the most common disease of the lower respiratory tract during the first year of life. Which is usually caused by respiratory syncytial virus. The treatment is usually supportive, so epidemiology, clinical, laboratory, and radiologic findings might facilitate early diagnosis and treatment of bronchiolitis cases.
Objectives: The aim of our study was to evaluate the clinical characteristics and laboratory findings of children hospitalized due to bronchiolitis.
Patients and Methods: In this cross sectional study 143 patients with bronchiolitis were selected who age 1-24 months old who were admitted to the Fallujah teaching hospital for women and children, over the period of 6 months from 1st of October 2018 to 1st of April2019. The patients were selected from large number of cases admitted to Hospital according to bronchiolitis criteria.
Results: A total number of 143 patients were included in this study, 52.4% were male and 47.6% were female. The most common clinical findings were tachypnea, dyspnea, cough, fever, wheeze consecutively. Hyperinflation was the most common radiological study, while lymphocytosis was the most common laboratory finding.
Conclusions: In our study Bronchiolitis was mostly diagnosed in the first 6 months of age, most of patients from urban area, tachypnea was most common sign while hyperinflation was the most common radiological finding and lymphocytosis was most common CBC finding. These data might facilitate early diagnoses and treatment of bronchiolitis cases.

Background: Postdate pregnancy is that pregnancy, which goes beyond 40 weeks gestation being calculated from the first day of the last menstrual period and first trimester ultrasound. It occurs in approximately 10% of singleton pregnancies. Perinatal and maternal complications of such pregnancies have always been underestimated.
Objectives: The aim of this study is to identify whether the prolongation of pregnancy beyond the expected date of delivery has negative effects on the health of both the mothers and the neonate.
Methods: A prospective case-control study of (600) pregnant women fulfilling the inclusion criteria( included: Gestational age range between (37 - 42 completed weeks), history of regular menstrual cycles and known date of the last menstrual period and/or with early pregnancy ultrasound and a singleton pregnancy with vertex presentation ), divided into (250) pregnant women as case group (beyond 40weeks of gestation) and (350) pregnant women as control group (between 37 completed weeks to 40 weeks of gestation).These mothers were admitted to the labor room at Basrah Maternity and Child Hospital from [1st of January to 1st November 2018].
Results: The majority of both cases and controls were between 18 and 30 years of age (62.4% and 56.3 % respectively).and multiparous (1_4) deliveries; 55.6% and 58% respectively). Among the cases, postpartum haemorrhage was the most frequent maternal complication (16.4%), followed by prolonged labour(15.2%), perineal tear (5.2%), cervical tear and shoulder dystocia (1.6% for both) . The newborns of postdate pregnancies tend to be heavier at birth, where (19.2 %) were macrosomic (birth weight ≥ 4000 g) and (51.6%) weighed (3500-4000g). The majority (77.6%) had an Apgar score of (≥ 7). Meconium stained liquor, meconium aspiration syndrome, admission to the neonatal intensive care unit and birth asphyxia occurred in (23.2%, 12.4%, 18.8% and 1.2%) respectively. There were no birth
injuries, intrauterine growth retardation or stillbirth in both cases and controls.
Conclusion: In postdate pregnancies, there is a definitive risk on mother and baby.

Intramuscular hemangiomas are rare asymptomatic angiomatous tumors , showing a slow growing pattern . We reported a rare case of biceps muscle hemangioma in a 22-years-old man who presented with progressive swelling following a simple trauma four years ago , after examining the patient with ultrasound (US) ,computed tomography( CT) scan and magnetic resonance imaging (MRI), which was confirmed by histopathology later on .