Iraqi Postgraduate Medical Journal

BACKGROUND:
Ampullary and periampullary tumors are composed of a group of malignant and benign neoplasms
arising in the region of the ampulla of Vater and are a major problem to the patients and surgeons and
their management remains a big challenge.
OBJECTIVE:
Study the age, sex distribution, presentation and management of patients with ampullary and
periampullary tumors in Iraq and compare it with other world reports
PATIENTS AND METHODS:
prospective study of 50 patients with ampullary and periampullary tumors carried out in GIT
hospital (tertiary center) from January 2013 to March 2015 ,risk factors ,age ,sex ,clinical
presentation ,images study ,diagnosis and modality of treatments whether curative or palliative are
studied.
RESULTS:
29 (58%) were males and 21 (42%) were females , about the age distribution the mean age was 45
,about the residency they were mainly from Baghdad in (40%) ,the presenting symptom was
obstructive jaundice in 43 (86%) ,duration of illness (range from 1-2 months) with the mean period
45 days , abdominal ultrasound study reveal distended Gallbladders in 76 % , dilated CBD in 82%
,dilated pancreatic duct in 56% , Hepatomegaly in 42% , dilated intrahepatic billiary tree in 64% , and
liver secondary in 10% .resection surgery was done in 50% ,palliative surgery in 12% and
endoscopic palliation in 38%
CONCLUSION:
Ampullary and periampullary tumors are relatively common. The mean age is 45 years, lower than
the western studies. Sex: male are affected 1.4 times more than female with male: female ratio = 1.38
. Abdominal ultrasound is very informative but EUS,CT scan and MRI, MRCP is the cornerstone for
the diagnosis, Normal looking papilla does not rule out occult ampullary tumor.

BACKGROUND:
Hydatid cyst disease remains a real health problem in many parts of the world. Surgery remains the
mainstay of treatment of liver hydatid disease. Laparoscopic hydatid surgery (LHS) is gaining
acceptance all over the world with promising early results.
OBJECTIVE:
To present our experience of laparoscopic management of liver hydatid disease in our locality.
PATIENTS AND METHODS:
All patients presented with liver hydatid disease to our department in Al-Jumhori Teaching Hospital
were planned to undergo laparoscopic hydatid surgery (LHS). The diagnosis was made by
abdominal ultrasonography and/or computed tomography. Surgical treatment was decided for cysts
larger than 4 cm. Exclusions from laparoscopic intervention were for patients with; multiple cysts (>3
cysts), complicated cysts, cysts at risky site, recurrent hydatid, and those who refused the
laparoscopic approach.
RESULTS:
From Sep 2001 to Jan 2013, 70 patients with hydatid liver disease were presented for surgical
treatment. LHS was performed in 46 patients; 15 were males and 31 were females. Their mean age
was 35 years (SD±14). In 13 cases the cysts were in the right lobe, in 5 cases were in the left lobe and
in 8 cases were in both lobes of liver. In one patient, there were 2 cysts in liver and one cyst in
spleen. In 9 patients (19%) the operation was converted to open surgery. The mean operative time
was 75 minutes (range, 40 – 120 minutes). The mean length of hospital stay was 3 days (range, 3-8
days). Pus collection in the residual cavity was occurred in two patients, who were managed by
laparotomy and drainage. Recurrence was detected in one patient 10 years after the LHS (2.3%).
There was no mortality.
CONCLUSION:
This study highlighted that laparoscopic approach for hepatic hydatid surgery is a safe and effective
method in selected patients.

BACKGROUND:
Laproscopy is a minimally invasive procedure allowing endoscopic access the peritoneal cavity after
insufflation of a gas (CO2)to create space between the anterior abdominal wall and the viscera for
safe manipulation.
OBJECTIVE:
Is to note the haemodynamic and pulmonary changes during laparoscopy in the early postoperative
period in comparison with open cholecystectomy.
PATIENTS AND METHODS:
30 adult patients of ASA class I and II studied in each group according to surgical procedure used
,monitoring used pulse oximetry ,non invasive automatic blood pressure measurement ,peak
inspiratory pressure and capnography.
RESULTS:
There is slight reduction of mean arterial pressure(MAP) and heart rate(HR) following induction of
anesthesiain both groups.Howevere,these effects tended to normalize in open cholecystectomy over
time while in laproscopy tend to normalize after desufflation.Postoperatively both groups sustain
significant reduction in oxygen saturation(SPO2) but in laproscopy was transient and clinically not
significant.
CONCLUSION:
This study show that laproscopy give better recovery and may decrease the need for postoperative
oxygen therapy.

BACKGROUND:
Prominent ear is one of the most common congenital deformities of the head and neck region. It can
affect the aesthetics and psychosocial aspects of patients. There are over 170 techniques described in
the literatures, but many do not adequately address the specific problem and can prove unstable.
Technique selection in otoplasty should be done only after careful analysis of the abnormal anatomy
responsible for the protruding ear deformity.
OBJECTIVE:
To evaluate the outcome of combined conchal excision, concho-scaphal sutures, and concho-mastoid
sutures techniques for treatment of prominent ear.
PATIENTS AND METHOD:
A retrospective study was performed on 38 patients, from February 2009 to September 2014. All
patients who had prominent ear were included in this study, except those who had constricted ear and
secondary otoplasty. A combined method of conchal excision, concho-scaphal suture, and conchomastoid suture technique was used for correction of prominent ear. The follow-up period was 6 –19
months (mean, 14 months). Data were entered and analyzed using the statistical package for social
sciences SPSS version (18).
RESULTS:
In 38 patients who underwent otoplasty for prominent ear (24 were males and 14 were female), this
technique of combined method used for all patients who had underdevelopment of antihelix and
conchal hypertrophy. This technique allowed for correction of prominent ears to achieve a natural
appearance. It achieved good to excellent symmetry in 95% of the patients and a low rate of
complications. There were no major complication like skin necrosis or infection, but one patient
develops small hematoma, another patient develops suture granuloma and extrusion and one patient
had mild telephone deformity.
CONCLUSION:
This Technique is simple, versatile and applicable to all age groups, as well as its easy, safe and less
recurrence rate with fewer complications and excellent long-term aesthetic outcomes.

BACKGROUND:
Right ventricular apical pacing is associated with alterations of left ventricular contraction
sequence and dilatation and may have a deleterious effect on left ventricular function.
OBJECTIVE:
The study investigates the correlation between left ventricular function and long term right
ventricular pacing.
METHODS:
In this study, 80 patients with permanent right ventricular apical pacing (VDD and DDD)
randomized to assess left ventricular systolic function particularly LVEF% .primary end point
was LVEF% after 1 year of pacing.
RESULTS:
In this study, the mean LVEF% was reduced after 1year of right ventricular pacing from
(67.47±2.94 to 55.89±8.41, p value 0.0001), with absolute reduction of about 12%.
Patients with LV systolic dysfunction (EF% less than or equal to 45%) which constitute 10
patients (12.5%) have mean baseline LVEF% (66.70±4.03 reduced to 37.50±6.38, P value
0.0001). Cumulative percentage of RV pacing and duration are predictors of LVEF% reduction.
CONCLUSION:
Conventional right ventricular apical pacing resulted in a significant reduction in the left
ventricular ejection fraction, particularly in patients with high percentage of right ventricular
pacing and should be suspected in any patients after long term pacing of right ventricular.
Functional rather than topographic criterion should be considered for optimal pacing.

BACKGROUND:
Antiepileptic drugs can induce changes in the electrocardiograph (ECG) records including
prolongation of QT interval but there is no evidence to link this effect with the sudden death that
reported in epilepsy. The new generations of antiepileptic drugs showed variable effect on the
heart. Lamotrigine did not prolonged the QT interval in healthy subjects while levetiracetam
prolonged the QT interval in patients cardiac channelopathy presented with congenital long QT
syndrome.
OBJECTIVE:
This study aimed to investigate effects of antiepileptic drugs that prescribed in a therapeutic
regimen to new cases of epilepsy as a part of management on the ECG records at the end of the
1st three months of treatment.
PATIENTS AND METHODS:
A total number of 25 patients, presented for the first time with epilepsy, were recruited from AlYarmouk Teaching hospital. Each patient was assessed clinically by consultant neurology prior
to enrollment in the study. An electrocardiogram (ECG) was obtained at the time of entry into
the study prior to the admission of the study and after three months of treatment with
antiepileptic drugs. In addition to the measurements of heart rate and different ECG intervals, a
QT-nomogram and cardiac restitution were used in analysis.
RESULTS:
At the time of entry, three patients had a significant short corrected QT interval (QTcB); four
patients had a borderline QTcB interval; and one patient had prolonged QTcB interval. QTnomogram revealed that many patients have abnormal interval and antiepileptic drugs
significantly reduced the relaxation phase of cardiac cycle and prolonged the ventricular
repolarization.
CONCLUSION:
Antiepileptic drugs carried a harmful effect on the heart and their assessment should be not
restricted in the measurement of QT interval before and after treatment or to study their effects
on the healthy subject as epilepsy is commonly associated with mutation of sodium and/or
potassium channels. Case finding of significant prolonged QT interval in respect to gender and
age, assessment of QT nomogram and cardiac restitution are useful tools to identify the patients
who are at risk of arrhythmias.

BACKGROUND:
Vitamin D deficiency and insufficiency are common in patients with End Stage Renal
Disease(ESRD). Vitamin D has been found to have beneficial effects on bone, cardiovascular
and immune functions. There are little data about vitamin D levels in Iraqi patients on
hemodalysis..
OBJECTIVE:
This study was conducted to determine the vitamin D status of Iraqi patients with ESRD on
hemodialysis.
PATIENTS AND METHODS:
This study is a cross sectional study conducted at The Dialysis Center/ Baghdad Teaching
Hospital . An eighty four patients with End Stage Renal Disease (ESRD) on regular
Hemodialysis (HD) enrolled in the study from January to February 2013.
The basic data of the patients had been obtained (age ,weight ,duration on HD (months),
infection with HCV, drugs doses for calcium and alphacalcidol . Blood samples were collected at
the start of the HD session from the vascular access for calcium, phosphorus, albumin,
cholesterol, uric acid and Vitamin 25(OH) D3 blood levels. These samples were sent for analysis
to the Teaching Laboratories at Medical City.
Patients were considered as vitamin D3 insufficient if the levels were between 10 and 30 ng/ml
, deficient if the levels were less than 10 ng/ml and sufficient if it was ˃30 ng/ml
We assess the correlation between vitamin D3 level and other variables tested in the study.
RESULTS:
The mean age of the patients was 49.8 ± 13.2 years, of these, 40 (47.6٪) were females and 44
(52.4٪) were males. Fifty five (65٪( patients were infected with hepatitis C virus and
29(35٪)were not . the median dose of calcium carbonate was 1086.1 ± 400 mg per day, The
median dose of alphacalcidol was1.9 ± 1.1 mcg /week. Mean weight was 68.8 ± 17.5 kg. Median
duration of HD was 24.8 ± 20.8 months (range 2–72 months).The patients were on twice a week
(6-8 hours/week) HD sessions.
Mean of serum albumin, corrected calcium, phosphorus, Uric acid cholesterol were 3.0 ± 0.8
g/dl., 8.6 ± 1.4 mg/dl, 3.9 ± 1.4 mg/dl , 6.1 ± 2.4 mg/dl, 149.9 ± 39.2 mg/dl respectively .
Mean vitamin 25(OH) D3 level was 33.02 ± 7.2 ng/ml. 60(71.4٪) patients were vitamin D3
sufficient, 23(27.4٪) patients were vitamin D3 insufficient and only one (1.2٪) patient was
vitamin D3 deficient.
There was a significant correlation between vitamin 25(OH)D3 levels and albumin , duration of
HD, virology status while there was no correlation between weight, sex ,age , activity, calcium,
cholesterol, uric acid , phosphorus ,dose of alphacalcidol or calcium carbonate and vitamin
25(OH)D3 level .
CONCLUSION:
The vitamin D insufficiency found in about one quarter of patients on hemodialysis while
deficiency found only in 1.2% of patients and more than two third of patients had sufficient
vitamin D3. There was a significant correlation between vitamin 25(OH)D3 levels and albumin ,
duration of HD, virology status.

BACKGROUND:
Poisoning defined as any substance causing a harmful effect when administrated accidently. Acute
accidental poisoning is important medical emergency in children worldwide.
OBJECTIVE:
To determine the pattern of accidental poisoning in children, the association between accidental
poisoning with gender and residence and to determine the clinical presentation and outcome of
each poison.
METHODS:
A prospective study was carried out in Childs Central teaching hospital in Baghdad for all children
bellow ten years with history of accidental poisoning during six months period Data including: age,
gender, residence, type of poisoning, presenting symptoms, and outcome were studied.
RESULTS:
Total number of children admitted were 10280 cases, of these 250 cases were presented with
history of accidental poisoning, accounting for (2.43%) of total cases admitted. Most of patients
(93.2%) were within age group of 1-5years.Males to females ratio was (1.27:1).Most common
poison was hydrocarbons(50.8%) followed by medications(31.2%) .Most of patients were from
urban backgrounds(78.0%).Vomiting was the most common clinical presentation(28.8%). (80.0%)
Patients discharged from emergency reception within 24 hours .The mortality rates were (0.8%) .
CONCLUSION:
Poisoning in children are well recognized problem and affecting large number of children. The
mortality rate was low.

BACKGROUND:
Nephrotic syndrome is primarily a pediatric disorder which causes heavy proteinuria ,
hypoalbuminemia , edema, and hyperlipidemia. Most children (90%) with nephrotic syndrome
have idiopathic nephrotic syndrome caused in 85% of the patients by minimal change glomerular
disease.
Valsartan is an angiotensin II receptor blocker approved in adults for the treatment of
hypertension, heart failure and it may also reduce proteinuria in nephritic syndrome.
OBJECTIVE:
The aims of this study are to assess antiproteinuric effect of valsartan in nephrotic syndrome in
comparison with propranolol and captopril , and to assess safety of valsartan in pediatric age.
PATIENTS AND METHODS:
A case control study was done for 104 patients who attended three pediatric hospitals ( The Central
Pediatric Hospital, Al- Elwyia Pediatric Hospital and Ibn Al-Baladi Hospital) where they were
newly diagnosed with minimal change nephrotic syndrome and 38 of them (36.5%) were
diagnosed with hypertension from 2006 to 2013 and they were followed up for six
months (course of disease treatment). Data collected in this study included: age, sex, time of
diagnosis and blood pressure was measured. Laboratory tests were done which include:
measurement of blood urea, serum creatinine, serum potassium , serum cholesterol, serum
albumin, hemoglobin level, liver enzymes (serum glutamate pyruvate transaminase, serum
glutamic-oxaloacetic transaminase and serum alkaline phosphatase ) and albumin in urine.
RESULT:
Despite comparable reduction in blood pressure among the 3 groups, angiotensin receptor blockertreated group showed statistically more significant reduction in proteinuria (amount and onset after
initiation of therapy) than other groups.
Drug-related adverse events were minor and infrequent, no patient developed dangerous increase
in serum potassium, renal function and liver function parameters nor dangerous decrease in mean
hemoglobin level.
CONCLUSION:
Valsartan is an effective and safe drug to be used in childhood minimal chang nephrotic syndrom
with rapid and consistent antiproteinuric effect even beyond its antihypertensive effect.

BACKGROUND:
The 21st century has been set to enhance dialysis adequacy. Numerous studies have confirmed the
association between the delivered dose of hemodialysis and patients outcomes. There is thus some
evidence regarding the relationship between dialysis dose and quality of life.
Aim:
To assess dialysis adequacy using (Urea Reduction Rate and KT/V), and to determine the association
between dialysis dose and different Hemodialysis characteristics in children with End Stage Renal
Failure undergoing Hemodialysis.
METHOD:
This was an observational cross-sectional study that was conducted for three months, from
(November 2014 till January 2015); we enrolled 50 children with End Stage Renal Failure in four
hemodialysis centers in Baghdad. Samples for blood urea (predialysis and postdialysis) were drown
to calculate the adequacy dose.
RESULTS:
Thirty two (64%) of patients were male and 18(36%) were females; with male to female ratio was
(1.7:1).The mean urea reduction ratio and Kt/V were 59.63 ± 7.345% and 1.29 ± 0.275, respectively,
with fair dialysis adequacy .A Kt/V less than 1.2 and a urea reduction ratio less than 65% were found
in 42%, and 38% of the hemodialysis patients, respectively. There was a significant correlation
between dialysis dose and (Blood flow rate, Dialysis hours, Dialysis frequency /week and Effective
surface area), while there was insignificance correlation with (gender, age, volume of ultrafiltration.
CONCLUSION:
Our results were better than neighbor countries with fair dialysis adequacy. It is important to
regularly measure the parameters of dialysis adequacy in order to assess whether targets are achieved
in accordance with K/DOQI guidelines.

BACKGROUND:
Neuroblastoma is the third most common childhood cancer, after leukemia and brain tumors, and is
the most common solid extra cranial tumor in children. The term neuroblastoma is commonly used
to refer to a spectrum of neuroblastic tumors (including neuroblastomas, ganglioneuroblastomas,
and ganglioneuromas) that arise from primitive sympathetic ganglion cells.
OBJECTIVE:
The aim of this research is to study the epidemiological and clinical feature of
neuroblastoma in a group of Iraqi infants and children who were admitted to the pediatric ward of
Al-Khadhimyia Teaching Hospital .
PATIENTS AND METHOD:
The study was done over a period of three months from 1st of Feb. 2010 to the end of Apr. 2010.In
reviewing all files, 18 cases were collected from the Pediatric Hemato-Oncology Consultation
Clinic in Al-Khadhimyia Teaching Hospital, they were diagnosed and treated consequently in the
pediatric ward / hemato-oncology unit over a period of 9 years (2002-2010). Data regarding age,
sex, residence, site of primary disease and clinical presentation were taken from the recording files
in the pediatrics Hemato-Oncology Clinic. Methods used to diagnose our patients includes, fine
needle aspiration of tumor mass, Bone marrow aspiration & biopsy of different sites.
Chemotherapy was the main line of treatment.
RESULTS:
The total number of studied cases was eighteen cases. The median age was 15 months with male to
female ratio of (0.63:1), 9 cases (50%) were below 1 year. Abdominal mass was the commonest
site of tumor 12 cases (67%), weight loss was the most common symptom 18 cases (100%)
followed by abdominal distention 14 cases(78%), abdominal mass represent the most common sign
in 12 cases(67%). Stage IV was noticed in 9 cases (50%), 10 cases (56%) were a high risk group,
7 cases (38.8%) had bone marrow metastases, 6 cases (34%) finished treatment and survive, 4
cases( 22%) relapsed, 2 cases(11%) died.
CONCLUSION:
The majority of cases were recognized during the first two years of age .Female were involved
more than male. The outcome of treated cases was good and accepted. Abdominal mass is the
commonest site , weight loss is the commonest symptoms

BACKGROUND:
Premature rupture of fetal membrane is one of the most common and controversial problem facing
the obstetric clinician. Its Correct diagnosis has great importance because failure of diagnosis can
lead to unwanted obstetric complications or over diagnosis can lead to unnecessary intervention.
OBJECTIVE:
To evaluate the reliability of vaginal fluid urea and creatinine for the diagnosis of premature
rupture of membrane.
PATIENTS AND METHODS:
This study had been conducted in AL-Yarmouk Teaching Hospital, Department of Obstetrics and
Gynecology. In this study,105 pregnant women presented between 24-41 weeks of gestation were
included, three groups were considered in this cohort, thirty five pregnant women with confirmed
premature rupture of membrane (group A), thirty five pregnant women with suspected premature
rupture of membranes(group B),and thirty five healthy pregnant women considered as control
group(group C).
All patients underwent speculum examination for amniotic fluid pooling, nitrazine paper test,
measurement of urea and creatinine in vaginal wash fluid sample, ultrasonographic examination for
gestational age determination and amniotic fluid index calculation, and then the patients were
followed up until delivery.
RESULT:
There was significant differences in the mean vaginal wash fluid urea and creatinine concentrations
among the three groups (P < 0.001), being higher in group A than the other two groups. The
gestational age at delivery and time interval between sampling and delivery was significantly
shorter among patients in group A than group B and group C.
CONCLUSION:
Vaginal wash fluid urea and creatinine determination for the diagnosis of premature rupture of
membrane in our study reported a comparable result in the sensitivity and specificity to other
worldwide results.

BACK GROUND:
Preterm birth still remains a significant management problem and a large number of markers were
investigated.
OBJECTIVE:
To assess the increasing of Corticotrophin Releasing Hormone(CRH) level in women diagnosed
with preterm labour and are of medical value.
Design: - Case control study .Al-Kadhymia Teaching Hospital.
METHODS:
Plasma samples of 80 women diagnosed with preterm labour were used in this study. Samples were
divided into three groups ,according to week of gestation (24th-28th, 29th- 32nd, 33rd-37th). CRH
values determined by ELISA . Twenty low risk women of control group were recruited near the end
of 2nd trimester, all of them delivered healthy infants at gestational age greater than 37 weeks.
RESULTS:
In a study population of one hundred pregnant women, eighty of them were diagnosed as preterm
labour and twenty women as a control group, sixty-four out of eighty high risk women delivered
preterm birth while the remaining sixteen of the same group delivered term babies. Our study shows
that CRH level is elevated in the women with preterm birth, and ranged between (18.30-
95.03)pg/ml., serum values of CRH were significantly lower in women with term birth ,and ranging
between (13.5-14.9) pg/ml, , the (p<0.001).The sensitivity of CRH was 80% while specificity was
100%
CONCLUSION:
Maternal serum CRH level was elevated in women who gave preterm birth compared with those
giving term delivery.

BACKGROUND:
Uremic pruritus is a common distressing complication of end stage renal disease and it is a common
problem in dialysis patients. It causes serious discomfort and skin damage, negatively affects the
quality of life.
OBJECTIVE:
To determine the prevalence, severity of pruritus and possible association with the laboratory
parameters in patients with chronic renal disease on haemodialysis.
METHODS:
One hundred and three patients on chronic haemodialysis were included in this study. Fasting blood
sugar, urea, creatinine, albumin, alkaline phosphatase, parathyroid hormone, sodium, potassium,
chloride, calcium, phosphorus, calcium × phosphorus product, were determined.
RESULTS:
Of the 103 patients included in the study the, 79 patients (76.7%) had pruritus of whom, 27 (34.1%)
had mild pruritus, 30 (37.9%) had moderate and 22 (27.8%) had severe pruritus. No significant
association (p ˃ 0.05) was found between pruritus and each of sex, age, frequency and duration of
haemodialysis. There was a significant association (p ˂ 0.05) between duration of haemodialysis
and pruritus onset. No significant difference (p ˃ 0.05) in the FBS, urea, creatinine, albumin,
parathyroid hormone, alkaline phosphatase, sodium, potassium, chloride, calcium, phosphorus,
calcium phosphorus product, average among patients who had no pruritus, mild, moderate and
severe pruritus. A significant positive correlation (p ˂ 0.05) was found between severity of pruritus
in pruritic patients and age.
CONCLUSION:
WE CONCLUDED THAT there was a significant association between duration of haemodialysis
and pruritus onset more over the age had a significant positive correlation with the severity of
pruritus in pruritic patients.

BACKGROUND:
Breast cancer is the most common malignancy in women, and a major cause of mortality and morbidity
despite the advances in diagnosis and treatment. There is evidence that changes in HER2 protein
expressions are associated with breast cancer progression.
OBJECTIVE:
To investigate whether measuring this tumour marker in serum of breast cancer patients before and after
treatment might also be useful markers in the diagnosis, screening and monitoring the malignant tumour
progression and response to therapy.
METHODS:
Serum samples were obtained from (28) apparently healthy women (Control Group) with a mean age of
40.9 ± 7.6 years and (60) female patients complaining from primary breast cancer (Patients Group) with a
mean age of 48.3 ± 8.9 years. They were divided according to their clinical end point into: Pre-Surgical
Group, Post-Surgical Group and post- chemotherapy Group. Serum Her-2/nue level was measured using
ELISA kits.
RESULTS:
Level of Her2/neu (3130.4 pg/ml) was significantly higher in after 6 cycles of chemotherapy group than
each of control (1400.8 pg/ml), before surgery (1597 pg/ml) and after surgery (1487.4 pg/ml) (P < 0.05).
Her2/neu is effective test only after 6 cycle chemotherapy with an accuracy of 95.2%. The best
performance for Her2neu was observed at values ≥ 1464 pg/ml (sensitivity = 95% and specificity = 61%).
There were significant influences of the studied personal and the pathological characteristics of the
tumour upon the biomarker levels where the levels were significantly higher with the increase of tumour
pathological stage and in the presence of positive status for Her2neu receptors (P < 0.05).
CONCLUSION:
In this study there was a statistically significant association between tissue HER-2/neu and serum HER-2
/neu levels in the extracellular domain. It could be concluded that using serum Her-2/neu in patients after
six cycles chemotherapy could predict response to therapy.

BACKGROUND:
During the last decade focused assessment with sonography for trauma increasingly has become
the initial diagnostic modality of choice in trauma patients.
OBJECTIVE:
This study was carried to evaluate the sensitivity, specificity and accuracy of FAST when done by
residents in the emergency surgical department, & its effect in determining the type of
management.
PATIENTS AND METHOD:
210 patients with blunt abdominal trauma were assessed with FAST within 30 minutes from
admission to the emergency room. FAST results were considered positive if it detected intra
peritoneal fluid , negative if it did not detect intra peritoneal fluid , and indeterminate (equivocal) if
the results were not conclusive.
In cases with negative Fast results and no other injuries were detected the patients were kept in the
emergency department for 24 hours for observation and discharged later on.
Those with indeterminate initial FAST or who deteriorated clinically after negative initial FAST
were subjected to repeated FAST and / or emergency abdominal and pelvic computed tomography
(C.T scan) or explorative laparotomy according to their clinical condition.
Patients with positive ultrasonography results underwent emergency abdominal or pelvic C.T, or
surgery according to their clinical picture.
RESULTS:
From the 210 patients included in the study we found that 177 patients (84.2) % had negative
FAST results, 22 patients (10.4)% had positive FAST results , 2 patients (0.95)% had false positive
results , 8 patients (3.8)% had false negative FAST results and 11 patients (5.2)% had equivocal
FAST results.
After exclusion of equivocal cases , FAST had sensitivity of (71.4)% specificity of (98.8)% ,
accuracy of (89.1)%, positive predictive value of (90.9)% and negative predictive value of(95.4)%.
CONCLUSION:
FAST is useful adjunct to the initial evaluation of blunt trauma patients with reliable accuracy &
high negative predictive value.
FAST had a great effect in determining the type of treatment especially in case of mass causality.
And using FAST by general surgeons helps in the determination of the type of treatment for
patients with blunt trauma.

BACKGROUND:
Spontaneous intracerebral hemorrhage (SICH) is defined as non-traumatic bleeding into the
parenchyma of the brain that may extend into the . head computed tomography scan is the standard
diagnostic tool
OBJECTIVE:
Find out the most important risk factor for SICH.and Illustrate the correlation between the sites of
hemorrhage detected by CT scan images and patients presentations.
PATIENTS AND METHODS:
A prospective study between May 2010 and May 2012; this study was done in the CT unit in ALImamain Kadhimmain medical city, Baghdad, The study included 224 consecutive patients with
the diagnosis of primary SICH.All the patients had primary spontaneous intracerebral hemorrhage
clinically diagnosed plus CT findings that showed evidence of intra-cerebral hemorrhage.
Statistical analysis was done using SPSS 15.
RESULTS:
This study included 224 patients, 128males and 96 females. Forty two patients lie in the age group
of 50-59 years, 66 between 60-69 years, 48 between 70-79 years, 52 patients are seventy years old
and older and only 16 are below fifty years of age. Regarding the site of bleeding 160 patients
(71.4%) had bleeding in deep seated areas of the brain and 64 patients (28.6%) had bleeding in a
superficial location. Regarding the deep seated hemorrhage basal ganglia was in 96 (42.8%) of the
patients, followed by Thalamus in 48 (21.4%), and cerebellum in 16 (7.2%) of the patients. In the
superficial sites of hemorrhage parietal lobe was in 40 patients (17.8%), then parieto-occipital
hemorrhage was in 16 (7.2%) patients and 8 patients (3.6%) had temporal lobe hemorrhage.
Hypertension was the most common risk factors, found in 75% of patients, followed by
antigcoagulant use in 57.2% of patients. A history of diabetes mellitus was positive in 39.3% of the
patients, 39.3% of them were smokers, and 25% patients had no history of any risk factors. A
statistically significant difference between deep & superficial bleeding is seen in correlation with
hypertension and smoking (P value is 0.00001 and 0.002 respectively) The focal neurological
signs, found in 66 patients, facial palsy in 48 patients, loss of consciousness in 40 patients, 32
patients had both focal neurological signs and loss of consciousness as a presentation, 22 of them
presented with speech difficulty, 8patients presented with ataxia and 8 with dementia. Significant
relationship was found between the site of hemorrhage and patients’ presentation (P value 0.001).
120patients had intra-ventricular extension of hemorrhage in their CT films, 120 patients had
pressure effect of the hemorrhage, and 104 were complicated by edema.
CONCLUSION:
Males are more affected than females by spontaneous intra-cerebral hemorrhage which tends to
occur more commonly in a deep seated area of the brain.Hypertension is the most important risk
factor. There is great correlation between patients’ presentations and the site of hemorrhage.
Patients 50 years and older are more liable for spontaneous intra-cerebral hemorrhage.

BACKGROUND:
Oxidative stress defines that, the level of Reactive Oxygen Species (ROS) exists in excess of
antioxidant defenses. This imbalance in the redox milieu results in a switch from ROSstimulated ambient signaling processes to ROS-mediated pathophysiological consequences.
Oxidative stress has been implicated in the installation and progression of several degenerative
diseases via DNA mutation, protein oxidation and lipid peroxidation. Therefore, possible use of
soursop fruit extract to protect brain against the Lipid peroxidation.
OBJECTIVE:
The present study was undertaken to evaluate the potential of Soursop (Annona Muricata L.)
against the DPPH Free Radical Scavenging System and Lipid peroxidation.
METHODS:
Phytochemical screening was carried out with fruit extract of A. muricata for the detection of
various phytochemicals. The extract was tested for the presence of glycosides, proteins,
saponins, tannins, phenolic compounds , alkaloids , flavonoids, steroids and vitamine C using the
standard procedures and then DPPH radical was estimated according to the method of Blois and
Lipid peroxidation was estimated according to the method of Rajakumar.
RESULTS:
The study showed that the Soursop (Annona Muricata L.) in the fruit extract contain : glycosides
, proteins, saponins ,tannins ,phenolic compounds, flavonoids , alkaloids , steroids and vitamine
C . Fruit extract were found effective in scavenging DPPH (78,6℅) in concentration
(250µl/ml), as well as inhibiting the lipid peroxidation (16.2℅).
CONCLUSION:
The results suggest that Soursop (Annona Muricata L.) treatment protects the rat brain against
lipid peroxidation and DPPH free radical scavenging.

Carcinoma of the body and tail of the pancreas
considered one of the most challenging tumors
due its retroperitoneal location and neighboring
major blood vessels. Therefore, it is often
presents at an advanced stage and is deemed
unresectable in the majority of patients.The
traditional approach of left-to-right PancreatoSplenectomy is associated with a high positive
tangential margin rate, is not based on the
described lymph node drainage of the organ, and
is associated with high recurrence rate.In 2003,
Strasberg SM described a novel approach for
resection of this part of the pancreas called
Radical Antegrade Modular PancreatoSplenectomy (RAMPS)which was introduced to
obtain a higher rate of negative tangential
margins and a higher lymph node count.This is a
case report of pancreatic tumor with celiac trunk
invasion treated by the new RAMPS procedure
with celiac trunk resection. Patient discharged
home on fifth postoperative day,follow up
reveals recurrence free survival one year later.