Journal of the Faculty of Medicine Baghdad

Thyroid cancer is a rare malignancy with wide interethnic and geographic variations (l).it constitutes 1% of solid organ malignancy (2) but they are still the most common endocrine (3)cancer .well differentiated (follicular and papillary thyroid carcinoma accounts for 80-90% of the approximately 28000 new cases each year and the estimate of 376000 existing cases of primary thyroid cancer in Europe and united states(2) , while in Germany it is the 13th most frequent maiignancy(2-7) new cases per 100000 inhabitantsK 1)-
There have been many recent advances in our understanding of thyroid diseases. An adenoma- carcii.oma sequence for the development of thyroid neoplasm has been based on the characterization of a number proto-oncogene and tumour suppressor gene, and different pathways for the development of papillary and follicular thyroid carcinoma have been demonstrated (5).
Over the past several decades, iodides supplementation to food supplies in many parts of the world has been followed by a correspondence decrease in the incidence . of follicular thyroid carcinoma (4).
The mean survival rates in papillary thyroid cancer usually exceed 90%, whereas in follicular thyroid cancer they amount to approximately 80% (1). For that reason differentiated thyroid cancer is considered among the most curable neoplasm (3).
The prognostic factors for papillary thyroid carcinoma are distant metastasis, age and extra thyroidal growth, and for follicular carcinoma they are distant metastasis, extra thyroidal extension and multifoccal growth Also in follicular carcinoma , survival is significantly influenced by some of the clinical variables , particularly loco regional extension of the disease and patients age (6,7,8).
The union international contre Le cancer and European organization for research and treatment score and the age , grade , extent and size scores are all highly significant(6,7).on the other hand .
Hormones, sex and lymph node metastasiss are not considering prognostic factors for survival (7).
A comprehensive study in Japan on 327- patients with thyroid carcinoma showed that in papillary carcinoma there is a difference in thtee survival between young (less than 45 years of age:))and old patients ( 45 years of age or older ). THk rate of patients who died of thyroid cancer also increased in cases with extra thyroidal tissue invasions, and metastasis to distant organs (7).

Background: Hypertension occurs in some patients with primary nephritic syndrome it may be mediated by changes in vasopressin activities or intravascular volume.
Aim of study: is to find out how many patients with idiopathic nephritic syndrome hare hypertension. Subj. & Methods: The study included 50 children (29 males and 21 females) with age ranger between
1- 13 years. Sixteen patients (32%) were with initial attack of nephritic syndrome, while thirty four patients (68%) presented with relapse.
Results: Nine (18%) patients had hypertension, eight (16%) patients were relapse cases, and one (2%>) patient was with initial attack. Hypertension was found in four (8%) patients with steroid resistant neurotic syndrome, three (6%) patients with steroid sensitive nephritic syndrome in relapse state and two (4%) patients with steroid dependent nephritic syndrome. Abnormal renal function was found in four patients (8%), two (4%) with hypertension and two (4%) without hypertension.
It is concluded the necessity of the follow up and periodical measurement of blood pressure of nephritic patients to allow early recognition and management of hypertension.
Conclusion: the necessity of the follow up & periodical measurement of blood pressure of nephroticpatients to allow early recognition & management of hypertension.

Background: Glucose -6- phosphate deosphate dehydnogenase (G6PD) deficiency is a common problem in Iraqi as well as in tropical A subtropical region.
Aim of study: to study the epidemiological aspect of G6PD deftaiency among Iraqi children. Patients & Methods: This cross sectional study was conducted in the Pediatric ward/A L Kadhiymia Teaching Hospital during the season of Fava beans ingestion. Patients who were presented with acute attack of pallor were collected , history was taken and physical examination was done.
Results : Ninety seven cases were studied, males were affected more than female with a ratio of 3.85:1, the peak of age was between ( 1 - 5years ), 76 cases ,(78.36%).Previous history of neonatal jaundice was found in 24 cases (24.74%), the acute hemolytic attack was precipitated by Fava beans ingestion in all of the cases ( !()()%) and pallor was the main presenting feature in all of them. The attack was very severe in 43 cases (44.32 %) with arrange of PCI’ between ( 1-9 %). History of recurrence was encountered in I 1 cases ( 11.34 %), family history of G6PD deficiency was found in 22 cases ( 22.68%) .G6PD level was estimated two months later in 31 cases (31.95 %) only and were found to be deficient.

Background: Squamous carcinoma accounts for majority of esophaged cancinoma Most patients with esophaged cancer are middle aged or elderly with make to female ratio 2.5:1.
Aim of study : to present a fairly representative picture of the carcinoma of esophagus in' yemen.
Patients& Methods: Seventy-six patients were treated for carcinoma of esophagus over a 5 - year period by cardiothoracic and vascular surgeon working in Sana a - Yemen. Amongst them there were thirty one men and forty-five women, with male/female ratio 1:1.45, age incidence (range 38 - 40year).
Results:. Adenocarcinoma was 65% of cases and other 35% was squamous cel! carcinoma. The major risk factors were founded chewing quat, silicon particles, thermal injury, diet deficient in vitamin, tannic acid (strong tea and sorghum wheat).
The mortality rate was more than 15%, 9% females and 6% mates.
Conclution: this study showes that acceptable early results for the treatment of esophaged cancer, can be obtained by a surgeon working in hospital with relatively basic facility . the cancer services may well improve long - term outcomes by facilitating both the deliver of multimodality conbined treatment <& the performance of large scale clinical trials . Although it is hoped that this wilt be accompanied by continuing improvement in surgical results.

Background: Alcohol remains the single most significant Cause of liver disease throughout the Western World, responsible for between 40 and 80% of cases of cirrhosis in different countries. Many of the factors underlying the development of alcoholic liver injwy remain unknown, and significant questions remain about the value of even very basic therapeutic strategies.
Patients and Methods: A total number of 113 patients with ALD attending the Gastroenterology and Hepatology teaching hospital between December 2001 and December 2003 were studied for the gastrointestinal, esophagogastroduodenoscopic manifestation of alcoholic liver disease.
Results.'The most common presenting symptom was jaundice (62.8%), anorexia, weight loss (39.8-54%) followed by hematemesis and malena (46.9%) and encephalopathy (40.7%). The pattern of the bowel motion was predominantly diarrhea (47.8%>), constipation (16.8%). The most common physical finding was hepatomegaly in (70.8%) followed by jaundice and ascites. The most common EGD jinding was esophageal varieses in (77%>), PHT gastropathy (52%), hemorrhagic gastritis (10.6%), GERD and lax cardia (8.8-15%) and esophageal candidiasis (4.4%).
Conclusion: In Iraqi patients with ALD, the most common clinical manifestations were jaundice and hepatomegaly. The pattern of the bowel motion was predominantly diarrhea. The most common EGD finding was esophageal varieses, hemorrhagic gastritis was prevalent and esophageal candidiasis may be a manifestation.

Background: Alcohol remains the single most significant cause of liver disease throughout the Western world, responsible for between 40 and 80% of cases of cirrhosis in different countries. There are no characteristic sonographic features of ALD. Many of the factors underlying the development of alcoholic liver injury remain unknown, and significant questions remain about the value of even very basic therapeutic strategies.
Patients and Methods: A total number of 50 patients with ALD were studied. Abdominal Doppler ultrasonography to determine the ratio of the left to right portal vein (PV) was done. They were compared with 50 healthy persons (control) and 50 patients with comparable CLD due to other causes.
Results: The diameter of the LT PV was 10.78 +3.37, 7.92 ± 1.56, 9.9 ±2.37 mm in study group, healthy control and CLD (not alcoholic) respectively. The diameter of the RT PV was 9.13 ± 1.96, 9.05 ± 1.59, 9.7 ± 3.37 mm in study group, healthy control and CLD (not alcoholic) respectively. The largest diameter of the LT PV was 19.2 mm and RT PV was 19.3mm. The smallest diameter of the LT PV was 4.8 mm and RT PV was 4.7 mm. There was significant correlation between LT-TR PV ratio of one or more and ALD.
In conclusion: The LT-RT PV ratio equal to or more than one was valid in sonographgic finding in the diagnosis of ALD

Background: Hydrocephalus is an imbalance of cerebro-spinal fluid (CSF) formation & absorption of sufficient magnitude to produce a net accumulation of fluid within to cerebral ventricles.
Aim of study: the main objective of this study is to compare frontal with post parietal shunt regarding the surgery complications , end results & then to compare it with other studies abroad.
Patient & Methods: this study included 920 patients admitted to the Neurosurgical department in the Hospital of surgical specialty,Medical city. The patients had full radiological study including MRI and CT . All patients were surgically managed & followed up for at least one year.
Results: results were & compared regarding the type of surgery we did (VP&VA)shunt. frontal or parieted with other studies.
Conclusion: frontal shunts can be as successful as post parieted shunts, & it carries less complications & lower mortalty although more difficult procedure & needs more experience

Background: Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease and the catheterization and angiography still considered (in most centers) as essential preoperative diagnostic step. This retrospective aimed at evaluating the catheterization and angiographic finding in our Iraqi patients with diagnosis of TOF
Patients and methods: The catheterization and angiographic study of200 patients with TOF-' referred to Ibn Al-Bitar Cardiac Center had been reviewed.
Results: There were 126 males and 74 females and their ages ranged from 11 months to 37 years. The catheterization data showed that 88% of the patients had equal LV and RV pressure. The evaluation of pulmonary artery pressure showed that all patients had normal pressure. The review of angiographic studies revealed that the perimembraneous VSDs were the most common type (91%> of the patients). 13 patients (6.5%) had coronary anomalies, and the patent ductus arteriosus is the most common associated anomalies.
Conclusion: The frequency of doubly committed VSD and single coronary artery were higher than other studies and we showed there was no indication to measure the pulmonary artery pressure during catheterization.

Objective To detect the changes in serum Lipids among Iraqi patients with active Rheumatoid Arthritis (RA) and the effects of drug therapy.
Patients and methods Fifty Iraqi patients with untreated active Rheumatoid Arthritis and 50 matched healthy control were studied with concentration on estimation of fasting serum Lipid profile which is repeated after 3month treatment with different disease modifying anti Rheumatic drugs (DMARDs) regimens.
Results Fifty Iraqi patients were included in this prospective study 47 females (94%) and 3 males (6%). The mean age of patients was (45±3.20).
fifty healthy individuals were included in this study as a control group 45 females (90%) and 5 males (10%) the mean age of the control group was (44.9±2.9).
Our results showed a significant reduction of VLDL, LDL, HDL, serum cholesterol and serum triglyceride in-patients with active RA (p=<0.05, 0.001. 0.001, 0.001 and 0.018 respectively). There was a significant relationship found between ESR and VLDL (P<0.05), serum triglyceride (P<0.04) and serum cholesterol (P<0.01). And there was a significant relationship between serum lipids and articular index VLDL (P<0.05), serum cholesterol (P<0.01) and TG (P=0.01).
After 3-months treatment with Methotrexate or Methotrexate + Chloroquine ± large dose steroid or Chloroquine alone.
There was a significant reduction of inflammatory activity and serum lipids return to levels similar to that of control group.
Conclusions:
The dyslipidemia associated with active RA characterized by low serum lipids and can be normalized by controlling disease activity with antirheumatic drugs including steroids.

Objectives: (I) to describe the hemodynamic and electrocardiograph (ECG) responses in patients with acute myocardial infraction (AMI) to a low level treadmill test (2) to assess the safety of low-level treadmill testing after AMI (3) to determine if information gained from the test can be used for discharge planning.
Methods: 50 consecutive patients with AMI were subjected for symptoms limited treadmill testing in the CCU of University Teaching Hospital Iraqi medical College, their age range was from 30-70 with mean age of 55 years. Blood pressure, heart rate, and ECG during a low level treadmill test studied 6 days after AML They were divided into two groups, group I those who could finish the test and group 2 those who couldn't finish the test.
Results: 38 patients (76 percent) completed the test. Fatigue was the main reason for the early stopping of the test. Between the rest and maximum exercise there was 12% increase in systolic blood pressure, 6 percent increase in diastolic blood pressure and 17 percent increase in heart rate. The resting systolic blood pressure, diastolic blood pressure and heart rate were significantly increased (p<0.05) in the patients who were unable to finish the test. ST segment elevation or depression> I mm was seen in 5 patients.
Conclusions: This low level treadmill testing was safe if it is done under supervised conditions. It provides an objective information about the patient’s readiness for discharge and a help in future management of the patients.

Background: Hirsutism is a common clinical problem which causes a great distress to the patient, which true incidence is unknown . However it is more common among Mediterranian women who are usually more accepting of their condition .
Aim of study : To determine the prevalence of hirsutism among adult females attendins the gynaecology out patient clinic at tikrit teaching hospital.
Patients & Methods: A sample of 175 adult non pregnant women (married & un married) with age range (18-25) years was included in this study .All attending the Gynaecology out patient clinic in Tiktrit teaching Hospital from Jan-Oct. 1999 .A full medical history was obtained. then patient were examined for pattern and severity of hair gowth . Grading was done usin , ferryman and Gallway scoring system .
Results : the prevalence of hirsutism was (35.4%) , when sevesity of hirsutism was assessed majority of patients (77.5%) had grade I hirsutism . yirilizing symptoms and signs were found in (69.3%) . the family history for the same condition in the family was positive in (24.1%) of hirsute women (67.8%) of hirsute women showed one or more of sonographic features ofpolycystic ovarian syndrome. The Body was found to differ in hirsute women compared to normal

Background &objectives: Angiogenesis plays an important role in the growth, progress and the metastasis of solid tumors. This study was done to determine the significance of angiogenesis as another prognostic factor in gastric carcinoma in an attempt to identify the patients at high risk of recurrences after surgical therapy who may benefit from postoperative adjuvant therapy.
In this study the correlation between the microvessel count(MVC) and the various clinicopathological factors was investigated. A highly significant statistical correlation was found between the mean microvessel count in different histological grades and the stage of gastric adenocarcinoma .
No correlation was found between the MVC and the age and sex of the patients , the size, location and the macroscopical appearances of the tumors
Patients and Methods: Fifty seven cases of gastric adenocarcinoma were reviewed from private pathology laboratories during the period between 2000-2002 , including 33 males and 24 females. The age ranged between 20-80 years ,the peak incidence was in the sixth decade . The specimens were formalin- fixed paraffin embedded, and the 5 microns thick sections were stained with Haematoxylin & Eosin stains .Immunohistological staining with CD 31 was performed on all sections. The microvessel count (MCV) was performed on the areas of the highest neovascularization i.e. hot spots. Five hot spots were selected the MVC was done under X200 magnification in light microscope .The relationship between the MVC and the various
clinicopathological factors were assessed. ( Statistical analysis was done using SPSS system version 10.0 computer software. Student “T” and “F” test were used and the differences were regarded as significant when the P value was less than 0.05.
Result:: Using CD 31 an endothelial cells marker monoclonal antibody shows that the MVC was 35 in well differentiated adenocarcinoma and 48.22 in the poorly differentiated tumors. In tumors with no serosal invasion the MVC was 26.5 while in case s with serosal invasion the MVC was 87.7. In cases of negative lymph nodes metastasis the MVC was 27.7 while in cases with positive lymph nodes metastasis the MVC was 43.56.
Conclusion : Evaluation of angiogenesis by counting the microvessels using the monoclonal antibody CD 31 as an endothelial cell marker on tissue sections proved to be a helpful and a useful prognostic factor to predict the poor prognosis in gastric cancer patients.

Background: Factor V Leiden mutation is the most common cause of hereditary thrombophilia . this mutation was found to be highly prevalent in the Eastern Mediterranean region , with recently reported prevalence of 3% in random Iraqi blood donors.
Aim of study: to document the case reports of factor V leiden in association with venous thrombosis in Iraqi patients.
Sub. & Methods: Six patients with Doppler confirmed Deep Venous thrombosis attending the Medical City Hospital were evaluated haemostatically and by PCR for the presence of factor Vleiden mutation. The patients had ages ranging between 22-60 years , and included 5 females and one male.
Results: Four were found to be heterozygous, while two were homozygous for this mutation by the DNA studies . the report includes a review of the relevant literature,and outlines the consensus opinion on indications of factor V leiden testing , and on the management of factor V Leiden associated Venous thombosis.
Conclution: All the cases in this report should have been routinely tested intinially for the factor V leiden mutation , & five out of them would be eligible candidates for long term or indefinite anticoagulation, with possible reduction in morbidity & recurrence risks.

Background: The accumulation of the lipid in the vascular smooth muscle cell within the arterial intima is a key process of the pathogenesis of atherosclerosis. Atherosclerosis is a degenerative disease of blood vessels leading to stroke.
Materials & Methods.One hundred and ten patients with acute stroke were included in this study 88 patients with ischaemic or infarction stroke and 22 patients with hemorrhagic type ) as well as thirty apparently normal healthy subjects as controls.
Results.Triglycerides levels and AI only were statistically significant in ischaemic type of stroke (P<0.005) while other lipid fractions were similar to the control values.
Conclusion: Acute stroke patients (infarction type) had significantly elevated TG and low Al. While those with hemorrhagic type had more or less similar lipid profile to normal control. In general the higher the TG level the poorer the outcome in patients with acute stroke.

Background: Prechordal plate is important midline structure in the head region. It has been shown that it plays a bivotal role in the development of the brain and the eyes.
Aim of study: There is confunsion, in the literatures and textbooks concerning of terms: prechordal plate, prechordal mesoderm and the Buccopharyngeal membrane. The aim of this work is to study is based on histological changes of the early stages of the chick embryo hoping to illuminate these aspects especially after the recent revival of attention to the importance of this region in the process of induction of the brain region of the newral tub & the development of the prosencephalon & the eyes as shown by genes activities & expression in the prechordal plate ..
Materials & Methods :this study is based on histological description of the early stages (4- 7H.&H.) of the chick embryo to illuminate the nature of these structures . It appeared that the cephalic foregut in the early stages is lined by tall endodermal cells that form three regions: Dorsal wall (PI) where it forms the prechordal plate and contributes to the formation of the prechordal mesodermal mass (mesoendoderm); the rostral end (P2), and the ventral wall (P3) where it fuses with the surface ectoderm forming the oral plate (or the Buccopharyngeal membrane). The contribution of endoderm to the head mesenchyme is emphasized in this study.
Conclution: this study indicated that the prechordal plate is not simply the Buccopharyngeal membrare it forms an early proliferating zone , rostal to the notochord , that contribute to the mass of prechordal mesoderm & another zone , which is extending later as a Sessels pouch , which also proliferate for some time . also the ventral extension is a part of Buccopharyngeal membrane.

Background: the integrity of cardiovascular reflexes & autonomic activities can be assessed by different tests and different techniques. However most of these studies carried out on male subject & usually on young group only .very little researches available concerning the differences in cardiovascular reflexes between male & female in different age group.
Aim of study: is to investigate the differences in cardiovascular reflexes in young , old male & female in response to go head up tilting using totally non- invasive system .
Sub. & Methods: this study was carried out in AL-Najaf teaching hospital on 85 normal sub. , 41 males c6 44 females they were divided into two age groups (20-40 years) & (41-60 years) for both sex. The blood pressure was measured by sphygmomanometer (BP) cardiac out put (Co) measured by Echocardiography technique, heart rate by ECG & the peripheral vascular resistance was measured by dividing the (BP) over (Co) according to Ohm’s law . All these measurements were first made in supine position at a study state & then all the measurements were repeated on 60 ’ head up tilting.
Results: the results indicate that there was a significant difference between the two sexes in both age groups by using this totally non - invasive system to measure all the above mention homodynamic variables.
Conclusion: this study provided great advantages for the investigation of abnormal cardiovascular reflexes in patients with orthostatic postural hypotension on the detection of some autonomic dysfunction or in case of prolonged bed rest after post operative surgery.

Background : It is quite accepted that interleukins (IL) in general play a crucial role in response to injuy , infection and on cogenic trans formation , among there are IL-6 and ILJO.
Aim of this study is to find out the possible role of IL_ and IL, 10 in colo rectaI carcima in Iraqi patients.
Subjects and Methods: forty patients with colorectal cancer (CRC) composed with 30 healthy controls were enrolled in this study. Serum conc. Of IL-6 and IL -lOwere estimated in both groups using ELIZA technique.
Results: Serem levels of IL-6 and IL-10 were significantly increased (P<0.001) in compassion with control group.
Conclusion: these cytokins could be used as a markers for tumor progression .

Summary
The vegetables are considered as an important source of human infection with intestinal parasites. Aims: to try a detection of the protozoal cysts or helminthic ova from vegetables collected from Baghdad markets.
Methods: The study was carried out during three months I'1 of September to the end of November 1999. Four different kinds of vegetables were selected for this study including tomato, onion, cucumber and celery. The vegetables soaked and washed in saline, centrifuged and the sediment examinedfor the presence ofprotozoal cysts, helminthic ova or fungi.
Results: Ova of Ascaris lumbricoides and Enterobius vermicularis were isolated from tomato and celery. Hookworm ova were isolated from celery leaves. Entamoeba histolytica cysts were present on tomato, celery and cucumber. Giardia lamblia cysts found on tomato and celeiy. In addition, the monilia (Candida albicans) and Geotrichum candidum were isolated from tomato and celery. Conclusion: Vegetables may play an important role in intestinal parasites infection.

Background: Extensive reports denote the biological role of trace elements (Cu Zn ", Se ') in many various physiological and pathological conditions, one of the list is shown to be Behcet's disease (BD).The aim of this study was directed towards the distribution of trace elements (Cu 2,Zn, 2,Se 2) in sera of BD patients, and control groups.
Methods: Fifty Arab Iraqi patients who fulfdled the ISO criteria for diagnosis BD.compared with 21 patients control with recurrent oral ulcer (ROU), healthy control groups (2Ihealthy relative and 21healthy volunteer). Typing HLA Class I was carried out at Alkarama hospital, by using microlympho-cytotoxicity test. The concentrations of serum Cu ', Zn ", and Se" were determined by atomic absorption spectrophotometry.
Result: Variation in levels of these trace elements as significant (P < 0.001) in Cu+2concentral and decreased (P Conclusions: Very unique striking results have come out of this study, and that is the significant increase in Cur2 level, significant decrease in Se 2 level, with non significanl decrease in Zn 2 level, were clearly observed in the patients studied groups in comparison with control groups. These results is another additional explanation to increase joint involvement occurrence in those patients ( our further documented results).

Background: Multiple tumors in the nervous system is a rare event..
Patient & Method: .A forty two years old male who was enjoying completely healthy life presented with one week history of a single attack of confusion .he was presented with double tumour in the brain operated up on our department by craniotomy.
Results: His neurological clinical examination was negative. A CT scan & MRI of the brain showed two intracranial space occupying lesions. A solid right frontal lesion and another cystic lesion in the third ventricle. . The pathology proved the frontal lesion to be a meningioma while the third ventricular tumour was colloid cyst. Post operative period was uneventful. Follow up for few months showed no complaint.
Conclution : Multiple Primary Tumor of the brain are uncommon & very to have a Meningioma assoaiated with colloid cyst of the 3rd ventnical in almost asymptomatic patimts.