Iraqi Postgraduate Medical Journal

BACKGROUND:
Colonoscopic procedure is an accepted modality for the evaluation of colonic disease and an
accurate procedure in the workup and screening of patients with lower gastrointestinal symptoms.
The clinical spectrum and diagnostic yield depend upon the indications for the procedure.
OBJECTIVE:
To identify the yield of the major indications for the procedure, and the pattern of colon pathology
in study population.
Study design and Setting:
A retrospective study was conducted over a period of 6 months extending From 18th November
2111 to 18th May 2112 at the National Center for Early Detection of Cancer by reviewing the
records of 224 colonoscopy examinations which were done in the center between January 2111
and December 2112.
RESULTS:
The patients comprised 66 females (26.42) and 158 males (71.6%) and their mean ages was
(46.6) years. There were 114 patients (51.62) who were aged less than 51 years. Complete
examination to the caecum was possible in 114 cases (51.62).
Pathological findings were identified in 127patients (56.72). The diagnostic yield of patients
referred for lower abdominal pain and alternation in bowel habit was low, of (26.722) and
(46.662), respectively. The yield was high for those with lower gastrointestinal bleeding (71.152),
diarrhea (61.62), category 'others' (652). The diagnostic pattern showed that non-specific colitis
and double colonic lesions were identified in (26.132), and (16.532) respectively. Colonic cancer
was diagnosed in 16patients (14.662), ulcerative colitis in 6patients (7.182), polyps were detected
in13patients (11.232), and internal hemorrhoids in17patients (13.382).
CONCLUSION:
The highest diagnostic yield of colonoscopy procedure was for lower gastrointestinal bleeding
and diarrhea and the main pattern of colonic pathology was nonspecific colitis and double colonic
lesions.

BACKGROUND:
Commonly we utilize veress needle in laparoscopic surgery as usual to start with introduction of
pneumoperitoneum in the abdomen (classic pneumoperitoneum], but there are alternatives to it for
better and fast work even in obese patients.
OBJECTIVE:
The purpose of this study is to compare direct trocar (DT) to Veress needle (VN) entry for tie
creation of pneumoperitoneum during laparoscopy with regard to the duration of the procedure
(trocar and Veress placement time), volume of gas used, ease of performance, and frequency of
complications through a randomized clinical study in Al-Karama hospital and some other private
Baghdad hospitals.
PATIENTS AND METHODS:
06 patients scheduled to undergo diagnostic and therapeutic laparoscopy (general surgery and
gynecology cases), 54 cases divided into DT (group A = 24) and VN (group B = 26), the other 84
cases were obese patients BMI>96, subdivided into two subgroups (8, 2) submitted for the study,
they were randomly allocated to either DT or VN entry for pneumoperitoneum. The laparoscopic
procedures performed by the same surgeon.
RESULTS:
The trocar and Veress placement time, volume of gas consumption, ease of performance and
frequency of complications were analyzed. The mean trocar and Veress placement time was
significantly shorter in group A and subgroup 8 than in group B and subgroup 2. The mean gas
consumption was significantly less in group A (2-9Iiters) and subgroup 8 than in group B and
subgroup 2 (5-0 liters). No major complications (bowel, vessels injury) in both groups were
encountered. Minor complications (failure pneumoperitoneum) were significantly less in group A and
subgroup 8 than in group B and subgroup 2.
CONCLUSION:
DT entry is a safe alternative to the VN entry technique for the creation of pneumoperitoneum. This
approach has further advantages with less cost and instrumentation along with rapid creation of
pneumoperitoneum even in obese patients.

BACKGROUND:
Acute appendicitis is a common clinical problem with an incidence of approximately 1 case per
10111 persons per year. Perforation is a common complication of appendiceal inflammation,
with an overall incidence of approximately %13 in pediatric populations and as high as 663 in
children younger than 5 years and up to 1113 in 1-year-olds. Computed tomography (CT)-
guided abscess drainage has also been shown to provide definitive treatment for 01–%13 of
abdominal abscesses
OBJECTIVE:
The aims were to report the role of CT-guided drainage of pelvic collection following acute
appendicitis, technical success and possible complications.
PATIENTS AND METHODS:
A prospective study was done in Al-Kadhimyia teaching hospital,between March 911% and
November 9119. The study included 84 consecutive patients with pelvic abscess following
appendicectomy for acute appendicitis. Age range was 11–54 years; 96 male, 19 female. All
patients underwent sonography and contrast-enhanced abdominal CT was performed to confirm
the diagnosis. CT guided drainage with a pigtail multi-sidehole catheter of 19 – 18 French was
done. Post-drainage scans were obtained to assess the position of the catheter and to exclude
early complications (e.g., hematoma). Catheters were flushed with 11-15 ml of 19%3 sterile
saline every 4 hr. to maintain patency.
The decision for catheter removal was based on the following criteria: clinical improvement
(normal body temperature and white blood cell (WBC) count, no clinical symptoms), drainage
output of 11 mL/d or less, and ultrasound findings of complete resolution of the target fluid
collection.
RESULTS:
The study included 84 patients. The depth of the collections was ranged from 8-4cm (mean of
6cm). Of the 84 patients, 81 had single drainage procedure, and 4 returned for a second
procedure. The (4484) necessitated a second drainage procedure (5cases of catheter displacement
and % cases of catheter obstruction). Treatment failure was seen in %484 (69953) patients and
were treated with surgical drainage. Clinical success of the procedures was (%%9053). The
volume of fluid drained ranged from 911 ml to 80511 ml (mean 881 ml). Fluid culture reveals
Escherichia coli in 903, and Enterococcus spp in 153 and polymicrobial in 543 of cases. hospital
stay was 1%6698 days (4–94 days), while those who underwent two procedures had an average
stay of 91996695 days. No catheter-related wound sepsis was noted at the time of discharge or
follow-up, and no catheter tract failed to close spontaneously.
CONCLUSION:
CT _guided drainage of pelvic abscess following acute appendicitis is an effective method of
treatment with no catheter-related wound sepsis and no major periprocedural complications.

BACKGROUND :
In laparoscopic surgery, the primary (first) trocar entry is of a great importance because of it’s
association with serious complications such as visceral and vascular injuries. There are several
techniques for laparoscopic entry, the commonly used ones are Veress Needle (closed) and Hasson’s (
open ) techniqes. Recently, the Direct Primary Trocar Insertion (DPTI ) without prior
pneumoperitoneum was reported as safe alternative laparoscopic entry technique .
OBJECTIVE:
This study assesses the safety ,feasibility ,complications and time of DPTI without a prior
pneumoperitoneum in laparoscopic surgery.
PATIENTS METHODS:
This is a prospective study included 122 patients ,221 females ( 5290 %) and 12 males (2590 %),
prepared for different laparoscopic procedures using only DPTI .Open laparoscopic entry ( Hasson’s
technique ) was reserved for patients with associated small umbilical hernias or previous mid-line
lapararotomy.Veress Needle ( VN ) and other methods of laparoscopic entry were not used.This study
was performed in AL-Karama Teaching Hospital/ College of Medicine / Wasit University,IRAQ from
April 1522 till July 1522 .Recorded data were : age,sex, indications for laparoscopic surgery,time of
DPTI , laparoscopic entry related complications, conversion to laparotomy , length of hospital stay and
the mortality.
RESULTS AND DISCUSSION:
DPTI technique was feasible in 155 patients (209) while open laparoscopy was reserved for the
remaining 22(0 %) patients . Conversion to laparotomy was done for 21 patients (0925 %) . This study
has no major complications nor deaths .
Immediate minor complications occurred in 5 patients (2919).Late minor complications occurred in 1
patients(195 %).Time of DPTI was 2955 ± 5912 SD minutes, P-value= 5952 . The follow-up period
ranged from 1- 15 months .
CONCLUSION:
DPTI entry is a safe alternative to the Veress Needle and other techniques of laparoscopic entry and
creation of pneumoperitoneum. It has shorter laparoscopic entry time than the other laparoscopic entry
techniques.

BACKGROUND:
Upper gastrointestinal bleeding is serious complication of portal hypertension which can be treated
by different medical and surgical methods with possibility of failure, re-bleeding and death.
OBJECTIVE:
To evaluate the efficacy of band ligation and Sclerotherapy in controlling initial bleeding, failure of
control (during first 25 hours) and re-bleeding within 4 days.
PATIENTS AND METHODS:
this prospective study was conducted at Gastroenterology and Hepatology Teaching Hospital in
Medical city complex in Baghdad from the 3st of January 2131 to the 3st of March 2132.
The study engaged 311 consecutive patients who were divided equally into two groups (41 patients
each), first group were treated with banding procedure while patients in second group were treated
with sclerotherapy and both groups were followed up for 4 days.
RESULTS:
Neither failure to control bleeding (during first 25 hours) nor death occurred in both groups.
Successfulness (no re-bleeding within 4 days) was more common in Band ligation group (%59) rather
than sclerotherapy group (%19). On the other hand, 6 patients in both groups all were child-pugh C
developed re-bleeding, 1 patients (89) in Band group and 4 patients (319) in sclerotherapy group and
need second session which was successful in all patients in both procedures , comparison statistically
was significant and Band procedure was better than Sclerotherapy procedure, (P.
value=1212%) .
CONCLUSION:
Endoscopic Band ligation is more effective than Sclerotherapy in controlling initial attacks of
esophageal varices bleeding and decreasing recurrent attacks of bleeding.

BACKGROUND:
Epithelial ovarian cancer is uncommon before 11 years of age but the incidence then rises steeply
until the mid sixth and seventh decades for which performance of transvaginal ultrasonography as a
screening test for ovarian cancer in asymptomatic postmenopausal women with an elevated serum
CA 325 had been performed.
OBJECTIVE:
Prospective ovarian cancer screening trial had been performed to estimate sensitivity, specifity and
positive predictive value of different ultrasound criteria for detection of index cancer (e.g. primary
invasive epithelial carcinoma of ovary) in postmenopausal women.
PATIENTS AND METHODS:
This study was carried out at the department of obstetrics and gynecology in AL-Yarmouk Teaching
Hospital from October 2112 through October2111.The study included 331 Postmenopausal women
≥ 15 years, they underwent measurement of serum CA325.Women with CA 325 of 11 IU/ml (or
more) were recalled for an ultrasound examination.
RESULTS:
Of the 331 women included in this study, 0 women underwent 11 scans during a follow up of one
year. The sensitivity for detection of ovarian cancer of different ultrasound criteria was 3111 for
abnormal ovarian morphology, 3111 for abnormal ovarian volume and 511 for complex abnormal
ovarian morphology. The highest specificity (3111) and positive predictive value (311 %) was
achieved by using complex abnormal ovarian morphology.
CONCLUSION:
A variety of ultrasound criteria had achieved high sensitivity, specificity and positive predictive
value for ovarian cancer screening in postmenopausal women with an elevated CA 325. Ovarian
morphology and ovarian volume used to interpret ultrasound had achieved increased sensitivity for
ovarian cancer screening. While complex abnormal ovarian morphology had achieved increased in
the specificity and the positive predictive value for ovarian cancer screening.

BACKGROUND:
Preeclampsia is essentially an endothelial disease. Early- onset preeclampsia appears to be linked
mainly to a failed placental vascular remodeling. Uterine artery Doppler is a validated noninvasive
surrogate of trophoblastic invasion and placental perfusion.
OBJECTIVE:
To evaluate the predictive capacity of uterine artery Doppler investigation for maternal and neonatal
complications in women with severe early- onset preeclampsia.
METHODS:
This prospective comparative study was carried out on sixty-five Iraqi pregnant women with severe
early-onset preeclampsia. Their gestational age ranged from 28-%4 weeks of gestation. A uterine
artery Doppler examination was performed on admission to the participants. According to the result
of Doppler ultrasound, they were arranged into two main groups: group one comprising twenty-nine
patients with normal uterine artery Doppler results, and group two comprising thirty-six patients with
abnormal uterine artery Doppler results. The maternal and neonatal outcome of women with
abnormal uterine Doppler results was compared to those with normal Doppler results, and then
results were analyzed accordingly.
RESULTS:
Sixty-five patients were enrolled in this study. In %%3 of them, uterine artery Doppler results were
abnormal. This group showed statistically significant lower birth weight (p = .0..%), higher
caesarean section rate (p= .0.14), abnormal umbilical artery Doppler examinations (p=.0...1) and
higher neonatal complications rate (P= .0..6). Regarding the maternal complications (HELLP
syndrome, neurological manifestations, acute renal failure and pulmonary oedema), occurred at
higher rate in the group with abnormal uterine artery Doppler compared with those having normal
Doppler results (%80%3 versus %7093), but only acute renal failure reached the statistical level of
significance (P=.0.17).
CONCLUSION:
Women with severe early-onset preeclampsia are at higher risk of maternal and neonatal
complications if abnormal uterine blood flow is present.

BACKGROUND:
Reference range basically originates in what is most prevalent in a reference group taken from the
healthy population. It is a basis for a physician or other health professional to interpret a set of
results for a particular patient. In our country it's preferable to redistribute a normal list of values
instead of the old one, taking into consideration a specific reference ranges for population with any
factor that may affects their measurement as, climate, type of food, and race. It should comprise
both sexes; all age groups and between which %59 of values of a reference group fall into after
enrollment of the inclusion/exclusion criteria.
OBJECTIVE:
To establish a reference ranges of some biochemical parameters for healthy adults' population.
METHODS:
one thousand healthy individual (aged 22-02 year), with 052 male and 552 female, selected from
Baghdad city, from AL-Mammon University College and Ministry of Health, were recruited for
the study between march.2211-april.2212 after they were subjected to an inclusion/exclusion
criteria, reference ranges of some biochemical parameters was constructed by using the parametric
methods to estimate 255 and %.55 percentiles of distribution.
RESULTS:
Specific ranges for some biochemical parameters shows somewhat a little bit difference in
comparison to their counterparts from other countries. Moreover it was clearly noticed that the
present dependent-format missed many important parameters as (HDL-Cholesterol), (LDLCholesterol) in addition to missing sex and age difference. Results also shows statistically
significant higher values in female than male for (HDL-Cholesterol) (p=25222), (Total Protein)
(p=25222), and lower values in females than male for (Uric Acid) (p=25222), (CREAT) (p=25222),
(Blood Urea) (p=25222).
CONCLUSION:
There is a need for the national clinical chemistry laboratory to establish its own ranges for both
sexes to all age groups, and to redistributes them in a new format.

BACKGROUND:
Toxoplasmosis is a zoonotic disease caused by the parasitic protozoan Toxoplasma gondii . This
parasite is an obligate intracellular organism and is found in two forms in humans. widespread
throughout the world, approximately half a billion humans have antibody to T. gondii.
OBJECTIVE:
This study aimed to compare the efficiency of two methods in diagnosis of toxoplasmposis in
pregnant and non-pregnant women.
METHODS:
Blood samples were collected from 357 (15-47 year-old, 177 pregnant and 257 non-pregnant)
females. Two serological methods were used: Latex agglutination test (LAT) and Enzyme linked
immune-sorbent assay for IgM detection (ELISA).
RESULTS:
The study showed that 31.173 of women had given positive results for LAT, of which 31 were
pregnant and 175 were non-pregnant, while only 14.213 of the total subjects had given positive
results for ELISA.
CONCLUSION:
These results indicate that positive sera for LAT should be further investigate by more reliable
method in order to confirm the infection with toxoplasmosis.
.

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 ROS-stimulated
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/or lipid peroxidation. Therefore, possible use aqueous extracts of
Miswak to protect brain against the Lipid peroxidation.
OBJECTIVE:
The present study was undertaken to evaluate the potential of Salvadora persica L. (miswak) against
the DPPH Free Radical Scavenging System and Lipid peroxidation.
METHODS:
The chemical components of the prepared aqueous extracts of Miswak were detected as: glycosides,
alkaloids, saponins, phenolic compounds, tannins, flavonoids , proteins ,steroids and Vitamine C.
and then estimate DPPH Free Radical Scavenging System and Lipid peroxidation
RESULTS:
The study showed that the Miswak ( Salvadora persica L.) in the aqueous extracts contain :
glycosides , proteins, saponins ,tannins ,phenolic compounds, flavonoids , alkaloids , steroids and
vitamine C . Aqueas extracts were found effective in scavenging DPPH(62.45℅) in concentration
(252µl/ml), as well as inhibiting the lipid peroxidation (42.24℅).
CONCLUSION:
Our results suggest that Miswak ( Salvadora persica L.) treatment protects the rat brain against lipid
peroxidation and DPPH free radical scavenging.
.

BACKGROUND :
Various left ventricular geometric patterns occur in hypertension and may affect the cardiovascular risk
profile of hypertensive subjects. Tei index is a combined index of systolic and diastolic functions and has
been shown to be a predictor of cardiovascular outcome in heart diseases.
OBJECTIVE:
The aim of this study was to investigate the relationship between Tei index and left ventricular (LV)
geometry in hypertensive patients.
METHODS :
Two dimensional-guided M-mode echocardiography and Doppler study were performed in 522
hypertensive patients and 76 control subjects. This study was conducted at Baghdad Medical City /
Teaching Hospital and Alshahed Mohammed B. Alhakem Hospital in Alshulla city . According to the
value of relative wall thickness (RWT) and left ventricular mass index (LVMI), hypertensive patients
were subdivided into four geometric patterns. The Tei index was obtained from the summation of
isovolumic relaxation time (IVRT) and isovolumic contraction time (IVCT), divided by the ejection time.
Statistical analysis was done using SPSS 5639.
RESULTS:
This study showed that the Tei index was significantly higher among the hypertensive patients with
concentric hypertrophy(CH), eccentric hypertrophy(EH), concentric remodeling and normal geometry
compared with the control group(9315.5.5, 9361.93., 9379.93., 9319.931 respectively). Tei index was
correlated to the left ventricular ejection fraction (LVEF), left ventricular fractional shortening(LVFS),
mitral E/A ratio, heart rate(HR), LVMI and RWT.
CONCLUSION:
The Tei index are impaired in all subgroups of hypertensive patients according to their LV geometry
compared to control group. This impairment is more advanced in patients with concentric and eccentric
hypertrophy.

BACKGROUND:
Non invasive measurement of intime-media thickness(IMT) of the common carotid artery by high
resolution ultrasonography and its importance in stroke patient.
OBJECTIVE:
The study was designed to study this relation in our locality.
PATIENTS AND METHODS:
Thirty patients with ischemic stroke that were admitted in the medical department of Al Yarmook
teaching hospital were tested by the aid of echocardiography department to measure intima-media
thickness of the common carotid artery and they were compared with 40 persons(matching age and sex)
without history of stroke or transient ischemic attack.
RESULTS:
The mean of IMT of common carotid artery in stroke pateints was 1242mm while in control group the
mean was 02965 mm.
CONCLUSION:
There is a significant relation between the increased IMT of common carotid artery and stroke.

BACKGROUND:
Uric acid can stimulate the synthesis of c-reactive protein, and that might be one of the mechanisms
underlying the endothelial dysfunction. Several studies showed an independent link between UA and
CRP suggest that chronic exposure to mild hyperuricemia may be a factor that contributes to micro
inflammation and raised CRP in individual the essential hypertension.
OBJECTIVE:
To investigate the relationship between the serum uric acid, C-RP , total cholesterol and endothelial
dysfunction in patient with essential hypertension.
PATIENTS AND METHODS:
Twenty patients with essential hypertension and fifteen apparently healthy subjects matched for age
and weight have been included in this study,uric acid and total cholestrol were determined by
enzymatic methods, high sensitivity C-reactive protein (HsCRP) enzyme immunoassyfor the
quantitative determination in human serum was used.
RESULTS:
The data obtained showed that the serum levels of uric acid, C-Reactive protein and total cholesterol
were significantly higher in patients with Hypertension than in healthy controls.
CONCLUSION:
The conclusion was that hyperuricemia in individuals with essential hypertension is associated with
endothelial dysfunction.the hypothesis that uric acid plays a significant role in this alteration in humans.

This research work concerns the realization and verification that an epidemic of plague had in
reality occurred 0444 years ago in Sumer , present day Iraq, that affected the population in a
catastrophic way and had lead to the decline and fall of the Sumerian Empire . This important
conclusion came after verifying the translations and transliterations of thousands of clay tablets
which was made available by scholars and international academic agencies . Of course there was
no mention clearly of the disease as we know now but there was a clear description of various
aspects of the disease including signs and symptoms, epidemic occurrence and effects on the
people and propagation through place over time which may have reached a pandemic proportions .
It was concluded that such an epidemic could be the main factor in the declining of the Sumerian
Empire. The epidemic itself could be a ring in the chain of plague epidemics propagated through
place in history and known nowadays as the black death,

BACKGROUND:
The cardiac effects of equipotent doses of pancuronium and vecuronium were compared in 90
patients, anaesthetized with thiopentone and maintenance with halothane. Heart rate and arterial
pressure were recorded from simultaneous tracings of ECG and pulse oximeter and automatic
noninvasive monitor respectively. Pancuronium (0000 mg/kg) caused a significant increase in
heart rate and significant changes in arterial pressure.The equipotent dose of vecuronium (0009
mg/kg) caused no significant changes in heart rate and arterial pressure.
OBJECTIVE:
The study was designed to determine the comparison between Pancuronium Bromide
&Vecuronium Bromide according to cardiovascular effects in young adult patients undergo
different variety of surgical operation under general anaesthesia.
METHODS :
Fifty adult patients (ASA class I and II ) were allocated to 2 subgroups: Group A (n=29)
received pancuronium bromide 0000mg/Kg Group B (n=29)received
vecuronium bromide 0009mg/Kg Anaesthesia was induced with Fentanyl
(%μg/Kg), Sodium thiopentone (4-6mg/Kg) and maintained with Halothane %1 in Oxygen.The
neuromuscular blocking agents were given and after 2-3 minutes tracheal intubation was
performed with ease in all patients. Heart rate and mean arterial pressure were recorded
every%0minutes in all patients for40 minutes.
RESULT:
There was significant differences in mean heart rate and mean arterial blood pressure in group A
(p<0009). There was no significant differences in mean heart rate and mean blood pressure in
group B (p<0009).
CONCLUSION:
From this study, it can be concluded that:
%- The use of pancuronium as a muscle relaxant cause significant increase in heart rate and mean
blood pressure in anaesthetized patients.
2- The use of vecuronium as a muscle relaxant cause insignificant changes in heart rate and mean
blood pressure in anaesthetized patients that lead us to prefer vecuronium on pancuronium for
hemodynamic stability.

BACKGROUND:
Renal failure is a disease characterized by loss of renal function and it affects all body systems.
Anasthesia for renal transplant recipient needs skill and care to
manage the abnormal systemic presentation of patient.
Anesthetic plan is affected by renal failure and effects appear by anesthetic drugs choices, doses,
and combination. This Anasthetic plan also affected by the cause of renal failure, drugs therapy,
dialysis, and duration of disease.
OBJECTIVE:
To assess the effect of remifentanyl infusion on total dose of atracurium required during renal
transplant surgery.
METHOD:
Between 1stJanuary-2011 to 1st February-2013, in renal transplant center, medical city-BaghdadIraq, and hundred patients had renal transplant. All patients had received midazolam
(0005Mcg/kg), fentanyl (1Mcg/kg), propofol sleeping dose (1-105mg/kg) and atracurium
(006mg/kg) then intubated.
Fifty patients were maintained with isoflurane (005-1 MAC), boluses of atracurium. Other fifty had
same maintenance with addition of remifentanyl infusion using infusion pump in dose of (0005-
001Mcg).
RESULT:
Group with remifentanyl needed less dose of atracurium than group without remifentanyl. Mean
dose for group with remifentanyl was (10255mg/kg) while for group without remifentanyl was
(10623mg/kg).
Mean time for surgery in both groups was approximately equal, in group with remifentanyl time
was (172016min), and other group was (174016min).
CONCLUSION:
Remifentanyl infusion decrease the dose of neuromuscular blocking agents required and may
abolish it but blood pressure and pulse rate should monitored carefully.

BACKGROUND:
Short painful procedures in pediatric age group like bone marrow aspiration (BMA) and biopsy
taking are day case operations which demand rapid recovery and minimal incidence of
postoperative complications.
OBJECTIVE:
To compare between intra & postoperative complications & the time of stay in the recovery room
for pediatrics undergoing short painful procedures under general anesthesia with either "ketamine
and thiopental" or "ketamine alone".
PATIENTS AND METHOD:
THIS IS A PROSPECTIVE RANDOMIZED clinical trial done in Children Welfare Hospital in
Medical City, Baghdad, Iraq, from August - November 2212 on 98 children patients who were
scheduled for short painful procedures. All patients were allocated randomly into 2 groups: the 1st
group (KT) received I.V ketamine 11 (1mg/kg) plus I.V thiopental 11 3-5 mg/kg (anesthetizing
dose) on induction and maintained on intermittent I.V doses of thiopental 11 in case of need. While
the 2nd group(K) received I.V ketamine 11 (1.5mg/kg) alone on induction and maintained on
intermittent I.V doses of ketamine 11(2.5mg/kg) in case of need. Any intra or postoperative
complications & the duration of recovery for all patients were recorded.
RESULTS:
It was found that the intraoperative complications (temporary & mild decrease in arterial O2
saturation and its associated breath holding, & cough) occurred more in the KT group, while the
occurrence of (mild involuntary movements and verbal responses) occurred more frequently in the
K group. The postoperative complications (nausea, vomiting, verbal hallucinations and dizziness)
occurred only in the K group. The duration of recovery is more prolonged in the (KT) group.
CONCLUSION:
The use of combination of thiopentone and ketamine is associated with more mild and temporary
intraoperative decreased arterial oxygen saturation, breath holding, and postoperative cough than
using ketamine alone, while the use of ketamine alone is associated with more mild involuntary
movements and verbal responses, postoperative nausea &/or vomiting, hallucinations, and
dizziness. The duration of recovery is prolonged by the use of thiopental.

BACKGROUND:
Bone erosion is a central pathophysiological process and an important outcome parameter in
rheumatoid arthritis (RA).
OBJECTIVES:
To assess prevalence of erosions in metacarpophalangeal joints (MCPJs) & proximal interphalangeal
joints (PIPJs) in RA using ultrasonography and to evaluate the associates if present.
PATIENTS AND METHODS:
Ninety two patients with RA diagnosed according to The 1897 American College of Rheumatology
(ACR) classification criteria for RA were compared with 169 healthy individuals matched for age and
sex. Disease activity score 29 joints (DAS29), erythrocyte sedimentation rate (ESR), C-reactive
protein (CRP), and rheumatoid factor (RF) were measured. Ultrasonography was performed using
Seimens Elegra with 7.6 MHz linear array transducer by radiologist for MCPJs and PIPJs.
RESULTS:
Erosions in RA were significantly more than those of controls (44 (47.94) versus 2(24) (p = 2.222).
Erosions in MCPJs were more than PIPJs and both MCPJs & PIPJs (33(764 ) versus 4(8.14 ) versus
7(16.84) respectively) (p=2.226). High ESR, positive CRP, and positive RF were significant
associates with the erosions (p= 2.229, p= 2.222, p= 2.222 respectively).
CONCLUSION:
Prevalence of erosions in MCPJs and PIPJs of RA patients was high (47.94).High ESR, positive CRP,
and positive RF were significant associates with erosions.

BACKGROUND:
Spondylolisthesis is a condition in which a vertebra slips anteriorly in relation to the vertebra below as a
result of pars defect or degenerative disease. The slipped segment produces abnormal positioning of the
vertebrae in relation to each other along the spinal column that causing back pain and neurologic
deficit.
OBJECTIVE:
There are debates about surgical maneuvers regarding low grade spondylolisthesis (grades I and II
according to Meyerding classification) whether to reduce the slipped segment or not, the aim of this
study is to determine the short and long term difference in the functional outcome between these
methods.
PATIENTS AND METHODS:
This randomized prospective study consist of 32 patients aged between 42-%3 years old (11 males and
21 females) treated for symptomatic low grade spondylolisthesis between October 2002 to November
2011 and followed up for 24 months. All patients were randomly divided into two groups: Group I (11
patients) underwent surgical reduction of the slipped segment, and Group II (11 patients) who
underwent in-situ fusion without reduction. Both groups had the same pre and postoperative
management.
RESULTS:
Early postoperative minor complications including one case in each group had superficial wound
infection (%6%6 and 16.6 in Group I and II respectively) which was controlled in the hospital, and one
case in each group (%6%6 and 16.6 in Group I and II respectively) had dural tear intraoperatively that
was repaired during the operation; none of patients had CSF leak postoperatively. There were two cases
in Group I (13636) and one case in Group II (16.6) had postoperative transient sciatic pain due to nerve
irritation. Depending on the Oswestry Disability Index (ODI), there was a significant statistical
difference between both groups in the short term (p-value = 0604), but there was no significant
statistical difference in the long term follow up between them (p-value =0633) regarding the functional
outcome.
CONCLUSION:
Surgical treatment of low grade symptomatic spondylolisthesis usually include neural decompression,
fixation and fusion; however reduction of the slipped segment is not necessary for these patients as the
ultimate outcome is similar to those who underwent in-situ fusion only.

ABSTRACT:
BACKGROUND:
Although a physical examination is regarded as the gold standard for diagnosis of nasal bone
fracture, adequate imaging of a nasal fracture is often required because of the legal consequences
that can result from the injury's cause.
OBJECTIVE:
The aim of the present study is to compare the validity of ultrasonography versus plain lateral Xray view of nasal bone in diagnosing different classes of nasal bone fracture.
METHODS:
This randomized clinical trial study included 225 patients presented with trauma to nose who
consulted Otolaryngology Department at Aljamhory Teaching Hospital, Mosul, Iraq for the period
from August 1556 to May 1552.
The results of plain lateral X-ray view and ultrasonography of the nasal bone were compared with the
clinical findings after oedema has subsided completely which is the gold standard for evaluating the
results.Moreover, accuracy rate, sensitivity, specificity, positive predictive and negative predictive
values of both plain lateral X-ray view and ultrasonography were calculated.
RESULTS:
The accuracy rate, sensitivity, specificity, positive predictive and negative predictive values of
plain lateral X-ray view in diagnosing nasal bone fracture were 58.85, 62.65, 81.05 ,60.55 and
00.05 respectively. Moreover, the accuracy rate, sensitivity, specificity, positive predictive and
negative predictive values of utrasonography in diagnosing nasal bone fracture were 28.85, 25.25,
25.25 ,25.25 and 25.25 respectively.
CONCLUSION:
The use of ultrasounography in the diagnosis of different classes of nasal bone fracture was found
to be superior to plain lateral X-ray view in accuracy rate, sensitivity, specificity, positive predictive
and negative predictive values.

BACKGROUND:
Tonsillectomy is one of the most commonly performed surgical procedures in otolaryngology. There
are several operative methods currently in use, but the superiority of one over another has not been
clearly demonstrated.
OBJECTIVE:
To compare intraoperative efficiency and postoperative recovery between dissection and coblation
tonsillectomy.
PATIENTS AND METHODS:
This prospective clinical study was conducted at Rizgary teaching hospital/ Erbil,and Baghdad private
hospitals from 22th November 2111 to 11th July 2112. The study included 111 patients who underwent
tonsillectomy, half of them by coblation and the other half by cold dissection technique. Both
techniques performed under general anesthesia. Each tonsillectomy technique was assessed
intraoperatively for amount of blood loss, and duration of operation. Postoperatively they were assessed
for pain, hemorrhage, and day of return to normal activity and normal diet.
RESULTS:
Duration of operations was significantly shorter for the coblation group versus the dissection group
(1171min vs. 2273 min, P= 17111). Intraoperative blood loss was statistically lower for the coblation
versus the dissection group (1573 ml vs. 1171 ml, P = 17113) There was statistically significant
difference in daily pain scores and return to normal diet and activity between the two groups (mean 571
day for coblation vs. 1732 day for the dissection, P= 17111). And only two patients (14) in coblation
group developed secondary bleeding.
CONCLUSION:
Coblation tonsillectomy offers better operative speed, intraoperative hemostasis, less postoperative pain
scores and faster recoveries than dissection tonsillectomy especially in pediatric age group.

BACKGROUND:
Color Vision Deficiency (CVD) is mostly an inherited trait and is not an uncommon problem.
Prevalence of CVD differs among different ethnic and geographic properties of the population that
affect their genetic constitution. Ishihara plates remain an internationally accepted tool for
screening red-green CVD.
OBJECTIVE:
To determine the prevalence of red-green CVD among adult males from Baghdad province.
PATIENTS AND METHODS:
One thousand and five (1445) adult males were enrolled in this study, using a systematic sampling
technique, and were screened for CVD utilizing 26-plate Ishihara plates and re-tested by
EnChroma 3,-Color plates. All males were residing in Baghdad and the center of Iraq.
RESULTS:
Among all tested males, ,62 reside in Baghdad province; of them, 46 showed red-green CVD; thus
making prevalence rate of 40750 in Baghdad province. The deutan/protan ratio was 207,.1.
CONCLUSION:
Prevalence of CVD among the people of Baghdad lies within the published range for Caucasian
males worldwide. Screening children/adult males for CVD from other provinces is recommended.

This case- report presents a successful operation
of a ruptured stomach , herniated through a defect
in the diaphragm , due to bullet injury which
remained in this position for three years , covered
by thick adherent pleura which sealed the stomach
INTRODUCTION :
Most cases of herniated stomach and intra thoracic
injury secondary to rupture diaphragm are due to
blunt trauma more than penetrating or perforating
injuries(3). Diaphragmatic injuries may be
undiagnosed in the acute posttraumatic period and
may remain unrecognized despite a variety of
chronic symptom (4).There is often a delay between
the trauma and the diagnosis .The diagnosis is
confirmed by chest X-ray , US , CT Scan and
barium studies