Iraqi Postgraduate Medical Journal

BACKGROUND:
Multiple sclerosis is an inflammatory demyelinating disease of the central system. It estimated to
affect more than 2・ 5 million people worldwide. It is the most common non-traumatic cause of
disability in young adults. Although the cause of multiple sclerosis remains undetermined, number
of risk factors for MS have been identified and they can loosely be put into one of two categories;
genetic or environmental components. Epidemiologic studies have suggested there is an increase in
incidence and prevalence of MS with increasing latitude north and south of the equator. Latitude
has implicate vitamin D status as a determinant of risk.
OBJECTIVE:
To study the association of vitamin D level with relapse rate and disability in patients with
relapsing remitting multiple sclerosis in Iraq.
PATIENTS AND METHODS:
Thirty patients (6 males and 24 females) with relapsing remission multiple sclerosis (RRMS), their
age range from 16 to 45 years, recruited from MS clinic of neurology department of Baghdad
teaching hospital in the medical city in Baghdad and twenty five completely healthy controls (6
males and 19 females) from general population and their age range from 20 to 40 years were
enrolled in this study in the period from April 2011 to the end January 2012.
RESULTS:
The present study shows low vitamin D levels for both patient with RRMS and control group.
There is significantly lower 25(OH)D level in patients with relapse compared with patients without
relapse in the last 6 weeks. Also we found higher expanded disability status scale (EDSS) in
patients with relapse compared with patients without relapse in the last 6 weeks. Lastly, we didn’t
find any correlation between vitamin D level and EDSS in patients group study.
CONCLUSION:
We concluded from this study that there is low circulating level of 25(OH)D in RRMS patients,
especially during relapses. Also there is no effect of vit D on disability

BACKGROUND :
To evaluate the long term prognosis (6 months of follow up) regarding mortality , acute myocardial
infarction and coronary angiography results in patients with troponin positive or negative in high
risk unstable angina pectoris .
METHODS :
All patients included in this study were adults, 73 patients, 52(71.24%) male versus 21(28.76%)
female of different ages . All had clinical features of ischemic chest pain of high risk unstable
angina. They attended private clinic in HIT city, Anbar Governorate ( West of Iraq ) during the
period January 2010 – December 2012. All had planner ST-segment depression in
electrocardiography (ECG) according to concordant ECG leads other ECG findings of T- wave
inversion or ST- elevation myocardial infarction were excluded, measurement of serum troponin
test was done for all patients. All patients included in the study were admitted to coronary care unit
(CCU) and received full treatment including heparin and discharged from hospital when they were
clinically stable. Coronary angiography was done for all patients and followed up for 6 months.
RESULTS :
From all patients included in this study 27(36.98 % ) were troponin positive unstable angina, 3
(11.12%) patients of them were died and 24 (88.88 % ) patients of them survived. Their coronary
angiography were sever type in 11(40.74 %) patients and they did coronary artery bypass
surgery(CABG) and 13(48.14 % ) patients had multiple lesions in more than one vessels and need
more than one balloon and stent(Percutaneous trans luminal coronary angioplasty PTCA) .While
those whom troponin negative unstable angina were 46( 63.02 %) patients all were survived, only 5
(10.86 %) of them need coronary artery bypass surgery, 27 (58.69 %) patients need single or
multiple stents , 4(11.5 %) patients had non critical coronary artery lesion only for medical
treatment and the remaining 11 ( 41.81 %) patients were had normal coronary angiography .
CONCLUSION :
Troponin positive high risk unstable angina carry poor prognosis where has 3 times more mortality
risk and more likely to be in need for surgery and difficult stenting and may not be able to be
treated surgically or by stenting but medically without intervention than negative troponin high
risk unstable angina .

BACKGROUD:
Primary percutaneous coronary intervention (PCI) provides outcomes superior to fibrinolytic
therapy in acute myocardial infarction (AMI), but no registry or study in Iraq has demonstrated its
use in hospital.
OBJECTIVE:
To evaluate using of primary PCI for acute MI in Ibn Alnafees hospital –Baghdad.
METHODS:
Patients between 2010 and march 2013 having symptom onset within 12 hours and either STsegment elevation of - 1 mm in - 2 contiguous leads or presumed new left bundle branch block
(LBBB) in electrocardiogram (ECG) who were treated with primary PCI were included in this
study. Two patient had cardiogenic shock treated within 16 hours.
RESULTS:
A total of 76 patient included in this study having primary PCI for acute MI. successful result
reported in 71 of cases, while death reported in 2 cases, slow flow in 2 cases, no re flow in one
case and stent thrombus formation in one case. No need for urgent or elective CABG.
CONCLUSION:
Primary PCI for patients with AMI having ST-elevation or new LBBB is a safe and effective
strategy

BACKGROUND:
Treatment of patients with newly diagnosed acute myeloid leukemia (AML) has improved during
the past decades due to the intensification of induction and post remission chemotherapies and due
to the incorporation of autologous and allogeneic transplantation procedures. Untreated acute
leukemia is a uniformly fatal disease with a median survival time shorter than 3 months.
OBJECTIVE:
To evaluate the outcome of induction and complications post induction in adult patients with Acute
Myeloid Leukemia(AML) in Baghdad Teaching Hospital
PATIENTS AND METHODS:
A total of 47 patients diagnosed as de novo AML who had been admitted within twelve months
from January till December 2012 in hematology unit of Baghdad Teaching Hospital were
included. Treatment of the 47 eligible patients for remission induction with standard intensive
treatment course consisted of the combination with standard-dose cytosine arabinoside 100
mg/m2/d continuous infusion on days 1 -7, with of doxorubicin in a dose of 30mg/m2 over half an
hour infusion on day 1 -3.Response to therapy was assessed for complete remission or persistence
of leukemic cell post induction. Pattern and severity of infections and their relationship with
granulocytopenia. were analyzed.
RESULTS:
The patients had a mean age of of 36.7 years ranged from 14 to 72 years. Performance status in
15 patients was 0 or I while the majority (43) patients was with PS of II-IV at diagnosis according
to WHO/ECOG performance status scale. Duration between symptoms of AML prior diagnosis till
suspicion of a diagnosis of AML at a referring hospital and confirmation of the diagnosis at our
institute have been assessed with( mean +SD) duration 32±22.1days.
of the 47 patients 22(47%) achieved complete remission post first induction (CR1)and further
5(11%) patients have CR2(after second remission) and 20(42%) was refractory to treatment. Focus
of infection during marrow hypoplasia have been identified in 26(59%) patients.
CONCLUSION:
Based on the current data ,the remission rate was nearly comparable to the results with other
reports . Intensification of anthracyclins and identification of cytogenetic and other independent
prognostic relevance are needed to obtain better results.

BACKGROUND:
Hyperlipidemia is a condition characterized by high quantities of lipids in the blood stream. Lipids
include cholesterol, triglycerides and phospholipids. Fats and cholesterol are generally processed
in the liver and carried on proteins in the blood, forming lipoproteins. Its complications include
pancreatitis, atherosclerosis, coronary artery diseases and stroke.
OBJECTIVE:
Is to estimate the prevalence of hyperlipidemia in the Iraqi young adults aged 20-40 years and to
shed a light on any significant association between some socio-demographic and life style
variables with hyperlipidemia.
SUBJECTS & METHODS :
A cross-sectional study was conducted from the first of December 2011 to the first of June 2012.
RESULTS :
The prevalence rate of any lipid abnormality (at least one abnormality) was 75%.The prevalence
rates of elevated serum total cholesterol, low serum high density lipoprotein cholesterol, elevated
serum triglyceride and elevated serum low density lipoprotein cholesterol were (32.5%, 38.5%,
29.5%, 30%), respectively. The prevalence rate of elevated TC/HDL ratio was 61%.
CONCLUSION :
There is a high prevalence of lipid abnormality in young adults of whom males had higher
prevalence than females but the difference was not significant.The significant associated risk
factors with hyperlipidemia were age, BMI, newly diagnosed or uncontrolled diabetic and
hypertensive patients, cholesterol/fat rich diet and type of cooking oil.

BACKGROUND:
There are no universally accepted criteria for distinguishing between benign and malignant ovarian
masses on the basis of ultrasound findings. Risk of malignancy indices have been proposed, but these
methods use complex calculations and study multiple parameters to develop a score. The detection of
normal ovarian tissue in the adnexal masses, the ovarian crescent sign, is highlighted as a single
ultrasound parameter prejudging the nature of adnexal mass as benign or malignant. It has been
reported that absence of the “ovarian crescent sign” is a more sensitive indicator of malignant nature
than the risk of malignancy indices.
OBJECTIVE:
To evaluate whether the presence of normal ovarian tissue adjacent to adnexal masses (the „ovarian
crescent sign‟) could assist in the preoperative differential diagnosis of these masses, and to compare its
accuracy with standard biochemical and sonographic indices.
METHODS:
Sixty four women with adnexal masses were included in this prospective observational study. Serum
cancer antigen 125 levels were measured and transvaginal and/or transabdominal ultrasound scans of
the adnexae were performed and the tissue adjacent to the mass was examined for the presence of the
„ovarian crescent sign‟. The risk of malignancy index was calculated and all the findings were
compared with the final histopathological diagnosis and the accuracy of each test was compared to the
others in the form of sensitivity, specificity, positive and negative predictive values.
RESULTS:
Fifty five out of sixty four women were found to have benign masses, one had a borderline tumor and
eight had invasive malignant lesions. Normal ovarian tissue „ovarian crescent sign‟ was seen in fifty
three out of fifty five women with benign lesions but it was not seen in any one of the nine women with
malignant lesions.
In the absence of the “ovarian crescent sign”, ovarian cancer was diagnosed with a sensitivity of 100%
and a specificity of 96.4%. For the cancer antigen 125 test, the sensitivity was found to be 77.7%,
specificity 92.7%; for the Risk of Malignancy Index, sensitivity was 55.6% and specificity was 89.1%.
CONCLUSION:
The “ovarian crescent” sign is a reliable sonomorphological feature that can help to exclude ovarian
cancer in patients with adnexal masses, while its absence highly indicates malignancy.

BACKGROUND:
Neonatal asphyxia is a major cause of neurologic morbidity and mortality. Recent studies
suggest increased nucleated red blood cells in neonates with meconium aspiration syndrome,
supporting that the pregnancy with meconium stained amniotic fluid is at high risk of fetal
hypoxia.
OBJECTIVE:
To evaluate the role of umbilical cord nucleated red blood cells as a marker of neonatal
asphyxia with meconium stained amniotic fluid.
PATIENTS AND METHODS:
This study was conducted at the Department of Obstetrics and Gynecology and Nursery
Department in AL- Kadhymia Teaching Hospital from April 2010 through April 2011as
prospective case controlled study. The study included one hundred pregnant women, who were
admitted to the delivery ward, they were arranged into two groups. Group one included fifty
women with meconium stained amniotic fluid, considered as study group and the other group
included fifty women with clear amniotic fluid, considered as control group. This for
determination of umbilical cord nucleated red blood cells and comparison between two groups.
RESULTS:
The percentage of abnormal nucleated red blood cells count (NRBCs) in the study group (30%)
was significantly more than the control group (18%) (P value =0.002).The mean nucleated red
blood cells count (NRBCs) difference was 3.69 units and it was significantly higher in the study
group than the control group (P value =0.0002).
CONCLUSION:
The nucleated red blood cells (NRBCs) count increase in cord blood of neonates with
meconium stained amniotic fluid compared to neonates of clear amniotic fluid.

BACKGROUND:
Polycystic ovary syndrome is a very common condition affecting 4% to 18% of women. Polycystic
ovary syndrome is associated with metabolic features and diabetes and cardiovascular disease.
OBJECTIVE:
To evaluate the effect of metformin on serum lipids in overweight and obese women with
polycystic ovary syndrome.
METHODS:
An observational prospective study conducted at AL- Diwanyia Maternity and child Hospital from
May 2011 to March 2013. All women in this study have BMI >27 (range) so, they are all
overweight and obese .The women randomized into two group; one group were recieved
metformin therapy for 4 months duration and the other group were kept on no therapy and followed
for the same period. All studied women were subjected to measurement of fasting Blood sugar, and
measurement of overnight fasting lipid profile which include total cholesterol, triglycerides, high
density lipoprotein cholesterol and low density lipoprotein cholesterol.
RESULTS:
For women who received metformin, there was significant increase in the level of high density
lipoprotein P = 0.04. The value of triglyceride although decreased after metformin treatment, the
difference was not significant P > 0.05.
Other parameters (cholesterol, low density lipoprotein cholesterol) showed no difference. Fasting
blood sugar was not changed during the study.
CONCLUSION:
Metformin have been shown to improve the lipid profiles leading to increase the high density
lipoprotein cholesterol, the main predictive of cardiovascular disease in the women with polycystic
ovary syndrome.

BACKGROUND:
Hirschsprung’s disease (HD) is a common cause of intestinal obstruction in children. Definitive
treatments consist of excision of the aganglionic segment and anastomosing the normal colon to the
anal remnant by trans anal swenson approach.
OBJECTIVE:
The purpose of this study was to evaluate the feasibility and safety of TESPT technique for
management of HD & its results.
PATIENTS AND METHODS:
It is aprospctive study ,where 33children (30 boys and 3 girls) with proven HD were treated at our
pediatric surgical department between April 2009 and November 2013. Their ages ranged from 6
months to 8 years. The case files were evaluated for age at operation, associated congenital
anomalies, operative time, intraoperative blood loss and blood transfusion, time to resume oral
feeding, hospital stay, postoperative complications, and postoperative continence state. The median
follow-up period was 12 months(range 3 to 21 months) . The diagnosis was confirmed by barium
enema &/or by partial thickness rectal biopsy for histopathological examination for all cases. Most
patients had a well-defined transition zone at or distal to midsigmoid colon on preoperative contrast
enema
RESULTS:
Male to female ratio was 10:1. one patient had positive family history for Hirschsprung's disease .
The definitive TESPT was done in the patients at a median age of 10 months( range 6 months - 8
years). Seven patients had primary pull-through without colostomy.The median operative time was
120minutes (range 90-150 minutes). The length of the resected bowel varied between 20cm and
42cm. The length of hospital stay was 3 to 5 days. The time to resume oral feeding was ranging
from 24-48 hours. There are 4 patients with recurrence of obstructive symptoms (retained piece) . 3
patients(9.09%) required readmission for treatment of enterocolitis. Postoperative adhesive
intestinal obstruction occurred in 1patient (3.03%). Soiling occurred in 3 patient out of
33pts.(9.09%). Perianal excoriation occurring in 7 patients(21.21%) ,1 patient(3.03%) was died.
CONCLUSION:
Tespt technique is both feasible and safe technique in properly selected children with rectosigmoid
HD in all ages. The technique is easily learned and is associated with excellent clinical results.

BACKGROUND:
Meatal stenosis is a condition that almost always is acquired after neonatal circumcision.
Circumcision is one of the most common surgical operations throughout the world, and meatal
stenosis is one its late complications. We evaluated the topical use of a lubricant jelly after
circumcision in boys in order to reduce the risk of meatal stenosis.
OBJECTIVE:
To evaluate the use of lubricant in prevention of postcircumcision meatal stenosis and other
complications.
MATERIALS AND METHODS:
From April 2010 to September 2012, 300 boys younger than 2 year old referred to AL-RAMADI
TEACHING HOSPITAL IN ANBAR,IRAQ and my clinic, were involved in a randomized
controlled trial. They were referred for circumcision. The parents in the study group were
instructed to use petroleum jelly on the circumcision site after each diaper change for 6 months. In
the control group, no topical medication was used. The children were followed up regularly and
evaluated for meatal stenosis, bleeding, infection, and recovery time.
RESULTS:
Three hundred boys younger than 2 years old participated in the study.
None of the children in the lubricant group developed meatal stenosis, while 91 (60.6%) in the
control group developed postcircumcision meatal stenosis (P 0 .0000) which is statistically highly
significant. Infection of the circumcision site was observed in 2 (1.3%) and 14 (9.3%) children of
the lubricant and control groups, respectively (P 0 .0004) which is statistically highly significant .
Two boys (1.3%) in the lubricant group and 29 (19.3%) in the control group had postcircumcision
bleeding (P 0 .0007) which is statistically highly significant.
Finally, the mean time of recovery in the lubricant group was 3.8 ± 1.2 days, while it was 6.9 ± 4.2
days in the control group (P = 0.03).
CONCLUSION:
Based on the findings of this study we can conclude that using petroleum jelly after circumcision is
considerably effective for reducing postcircumcision meatal stenosis and other complications.

BACKGROUND:
The thyroglossal duct cyst results from a failure in obliterating the embryonic duct produced during
thyroid migration and it represents the most common type of developmental cyst encountered in
the neck region. Ectopic thyroid tissue neoplasia is rare, and it is even rarer when associated with
the thyroglossal duct cyst.
OBJECTIVE:
To study the clinical behavior, distribution and treatment of thyroglossal cyst and fistula.
MATERIALS AND METHODS:
A prospective study carried out during the period 2002-2011, in the otolaryngology departments of
Al Diwaniyah Teaching Hospital and Gazi Hariri Hospital, 72 patients suffering from thyroglossal
cyst and sinuses were diagnosed and treated (60 cysts and 12 sinuses). The data were collected on
the basis of history, physical examination, investigations, management and follow up.
RESULTS:
A seventy two patients complaining from thyroglossal duct cyst and sinuses were diagnosed and
treated. 45 male (62.5%) and 27 female (37.5%). The commonest age of presentation is the second
decade, 33 patients (46%). The most common clinical presentation of thyroglossal duct cyst is a
midline neck mass and a midline anterior neck discharging opening in cases of thyroglossal
sinuses. The thyrohyoid region is the most common location of both thyroglossal cysts and sinuses.
The histological diagnosis in all the cases was benign (100%). All the patients were managed by
Sistrunk s operation. The recurrence was seen in only one patient (1.3%). The incidence of
carcinoma in the cysts or sinuses was 0.0%.
CONCLUSION :
Thyroglossal cysts and sinuses are quite prevalent. Thyroglossal cyst usually appears as a midline
swelling in the prehyoid region of the neck. The etiology of thyroglossal sinuses in this study is
mostly iatrogenic which means more awareness is required about diagnosis and proper
management of thyroglossal cyst. The standard surgical approach is Sistrunk operation for both
thyroglossal cyst and sinuses with low recurrence rate.

BACKGROUND:
Ganglions are the most common benign cystic swellings found around the wrist, they can be treated
conservatively or by different surgical techniques. Our surgical modality (excision of ganglion complex
with fat graft) has given encouraging results.
OBJECTIVE:
To compare the efficacy of excising dorsal wrist ganglions and fat graft and excision alone .
PATIENTS AND METHODS:
A prospective study was conducted on patients with dorsal wrist ganglions. Surgical procedure in 25
cases was excision of the cysts and its neck , while for the rest 25 cases, excision of the cysts followed
by fat graft, then an immobilization for 7-10 days.12-18 months period of follow-up was adopted for
detection any recurrence.
RESULTS:
Most of the patients were females. Most of the patients presented mainly because of cosmetic reasons.
Recurrence was the most frequent complication encountered and involved 16 % in those of group A
and only 4% in those of group B.
CONCLUSION:
The technique of excision of dorsal wrist ganglions and fat graft is simple and effective.

BACKGROUND:
Conversion from laparoscopic cholecystectomy to open procedure should not be considered as a
failure; in fact it is an option which should be considered under certain circumstances.
OBJECTIVE:
Calculation of the conversion rate from laparoscopic to open cholecystectomy and identify its direct
causes and some of its risk factors.
PATIENTS AND METHODS:
Prospective study conducted in Baghdad teaching hospital and nursing home hospital in medical city
complex for two years period. Patients with symptomatic gall stones were included in the study and
prepared for laparoscopic cholecystectomy all cases were operated upon as elective cases.
RESULTS:
Two hundred and twenty one (221) patients were enrolled in the study, 177 female and 44 males with
female to male ratio 4:1. The mean age of the patients was 38 year .six patients required conversion
to open cholecystectomy with all over conversion rate 2.7%. In males the conversion rate was 4.5%
and in female it was 2.2%.
CONCLUSION:
Conversion rate in our study is within the lower limits and accepted internationally. Dens fibrous
adhesion is the main cause of conversion. History of acute cholecystitis is independent risk factor for
conversion from laparoscopic to open procedure. Gender, age and history of jaundice or ERCP are
not independent risk factor for conversion

BACKGROUND:
The detection of carcinoma of prostate (CaP )by trans rectal ultrasound (TRUS) depends on the feature
produced by the new growth , which leads to changes in the glandular —stromal architecture, appears
as Changes in the echogenicity of the prostatic lesion. The fine needle can be guided to the area of
suspicion and cytology is done.
OBJECTIVE:
This prospective study was conducted to demonstrate the usefulness of the fine needle aspiration
cytology (FNAC) under transrectal ultrasound (TRUS) guidance in detection of carcinoma of the
prostate (CaP).
METHOD AND PATIENTS:
Fifty male patients aged between (46 - 86) years, were chosen selectively, all with voiding symptoms &
suspicion of CaP from an elevated prostate specific antigen (PSA) above the level of 4 ng\ml in all
patients. Thirty patients had abnormal finding on digital rectal examination (DRE), thirty three patients
had TRUS abnormal findings. This procedure was carried out in out – patient basis. The cytological
results were compared with the tissue diagnoses obtained by surgical interventions.
RESULTS:
The cytological results revealed 24 case of malignancy & benign in the rest 26 case (23 case of BPH &
3cases of prostatitis).Malignancy was correctly diagnosed by using cytology in 24 out of 28 case
confirmed by histopathology as CaP. One case was considered initially as false positive, the cytological
result consistent with adenocarcinoma but the histopathology failed to prove it.
The statistical analysis revealed that the sensitivity, specificity and accuracy were 85%. 100% & 92%
respectively.
CONCLUSION:
We conclude that FNAC under TRUS guide can be considered as an initial safe cost effective &
reliable method for diagnosing of Prostate cancer.

BACKGROUND:
Modic type I changes/bone edema in the vertebrae are present in 6 % of the general population
and 35–40 % of the low back pain population. It is strongly associated with low back pain.
Chronic Low back pain (CLBP) is a leading cause of disability. It occurs in similar proportions
in all cultures, interferes with quality of life and work performance, and is the most common
reason for medical consultations.A new method of treatment included the use of antibiotic in
management of CLBP with Modic type I changes has proved to be effective in some cases.
OBJECTIVE:
The aim was to test the efficacy of antibiotic treatment in patients with chronic low back pain
(>6 months) and Modic type I changes (bone edema).
PATIENTS AND METHODS:
The study was a randomized clinical trial(RCT) with 71 patients whose only known illness was
chronic LBP of greater than 6 months duration occurring after a previous disc herniation and
who also had bone edema demonstrated as Modic type I changes in the vertebrae adjacent to the
previous herniation. Patients were randomized to either 100 days of antibiotic treatment or
placebo and were evaluated at baseline, and end of treatment.
Outcome measures: are the disease-specific disability Questionnaire, which is Roland Morris
Disability Questionnaire (RMDQ) and lumbar pain.
RESULTS:
43 of the 71 original patients were evaluated at baseline and at end of treatment follow-up. The
two groups were similar at baseline. The antibiotic group had better improvement on the
outcome measures and improvement continued after end of treatment. At baseline, 100 days
follow-up the means of the disease specific disability-RMDQ changed: antibiotic 15.5, 12;
placebo: 15, 14.8. For Lumbar pain: antibiotics 6.4, 4.8; placebo 6.1, 6.0.
CONCLUSION:
The antibiotic protocol in this study was more effective for this group of patients (CLBP
associated with Modic changes type I) than placebo in the outcomes.

BACKGROUND:
Anterior cervical discectomy and interbody fusion (ACDF) is a surgical technique used to treat a
variety of cervical spine disorders, such as nerve root or spinal cord compression, cervical
spondylosis, and cervical spinal stenosis (1,2).
OBJECTIVE:
To evaluate the clinical outcome of ACDF with an autologous iliac crest graft (AICG) versus
ACDF with an artificial anatomical cervical cage made of polyethereterketone (PEEK) filled with
artificial bone substitute for patients with cervical spondylosis.
METHODS:
This was a nonrandomized prospective study of 68 patients ( 28 females,41.2%), and (40
males,58.8%) with mean age of 59.4 years, who had symptomatic cervical disc degeneration
(CCD) and underwent ACDF from 1 st February 2010 till 1 st of September 2013.
We divided the patients into two groups, group A made of 25 patients underwent ACDF by using
AICG and group B made of 43 patients underwent ACDF by using anatomical cervical cage
(PEEK) filled with bone substitute.
All patients were evaluated preoperatively and six months postoperatively by using Neck disability
index (NDI), and Visual analogue scale (VAS) for radicular pain, neck pain and headache.
RESULTS :
For group A, the postoperative improvement in NDI was statistically significant, and for VAS the
postoperative improvement was statistically significant for radicular pain, neck pain and headache.
For group B, the postoperative improvement in NDI was statistically significant, and for VAS the
postoperative improvement was statistically significant for radicular pain, neck pain and headache.
The difference in postoperative improvement between group A and B was statistically not
significant for NDI, and VAS (radicular pain, neck pain and headache).
CONCLUSION:
Both methods are effective in treating cervical spondylosis in selected patients.
No method is statistically superior to another in 6 months postoperative clinical outcomes by using
NDI and VAS for radicular pain, neck pain and headache.

BACKGROUND :
Hemophilia is a bleeding disorder caused by deficiency of clotting factor VIII or IX; it is inherited
as sex linked recessive pattern. Musculoskeletal complications in haemophilic patients are
disabling. Bleeding in to the large joints and soft tissues are associated with arthritic changes in the
joints and contractures in the soft tissues. Deformities of the large joints especially flexion
contractures are commonly seen in knee joint. It is important to prevent deformities, treat existing
contractures and prevent recurrence to improve the patient's quality of life.
OBJECTIVE:
This is a retrospective study analyzing the effectiveness of gradual manipulation and serial casting
for treatment of knee joint flexion contracture in Hemophilic Iraqi patients.
PATIENTS AND METHOD:
We included ten Hemophilic patients type A, treated between 2006-2008, six with unilateral and
four with bilateral knee joint flexion contractures, excluding patients with multiple joint
contractures other than knees, have severe arthritic changes, have subluxated unstable knees or
have acute bleeding. Their age is between 16-22 years, the duration of deformity is 4-9 months,
knee flexion contractures between 20-80 degrees and all of them don’t have significant pain but
their daily life is severely restricted by the deformity. Under factor cover, general anaesthesia and
haematological care, we started serial manipulations and plaster of Paris casting, the number of
casts is between 2-6 casts, till we get straight knees. After that splints are prescribed for the patient
and followed up for a minimum 6 months, physiotherapy to strengthen the muscles around knee is
initiated from the start and gradually increasing after the application of the removable splints.
RESULTS:
We have ten patients with fourteen deformed knees, after manipulations and serial casting 8 knees
get full correction, and 6 knees still have less than 10 degrees of flexion which is acceptable for the
patients, all the patients have improvement of their quality of life and walk free of pain after 2
months.
CONCLUSION:
Serial manipulation and casting under general anaesthesia is a very good maneuver to correct knee
joint flexion contractures in hemophilic patients.

BACKGROUND:
The use of topical steroids on the face should be carefully selected by the dermatologist, however its
misuse still occur producing dermatological problem resembling rosacea.
OBJECTIVE:
To highlight the clinical aspects of misusing topical corticosteroid on the face and to search for the
causes behind this medical and social problem.
METHODS:
In this prospective study, 110 Iraqi patients with steroid rosacea or perioral dermatitis with history of
topical steroid use on their faces for at least 1 -3 months were evaluated at Department of Dermatology Baghdad Teaching Hospital between January 2011 to December 2013.
RESULTS:
Majority of patients were young, poorly-educated women who used a combinations of potent and very
potent topical steroid for average period of 0.25-12 years. Facial erythema (92.7%) and hotness (89%),
dryness (62.7%), telangiectasia (53.6%) and rebound phenomenon (86.3%) with or without
papulopustular eruption were the main clinical complaints. Searching for beauty and facial fairness in
51(46%) of patients, hyperpigmentory problems like melisma in 40(36%) patients were the main
indications for steroid misuse on the face mostly accomplished through recommendations from nonmedical personnel.
CONCLUSION:
Topical steroid should not be used on the face unless it is under strict dermatological supervision and
the easy access to topical steroid preparations must be controlled by the health penalties.

BACKGROUND:
Pre-emptive analgesia is important for reduction of post operating pain in all surgical procedure
including inguinal herniorraphy under, general anaesthesia.
OBJECTIVE:
To compare the effectiveness of pre-emptive analgesia for reduction of post-operative pain in inguinal
herniorrhaphy under general anaesthesia.
PATIENT AND METHOD:
30 adult ASA1 male patients undergoing inguinal herniorraphy under general anaesthesia were
included in randomized prospective clinical study. The patients classified into two groups. Group 1
(n=15) control group receive 20 mg Ketamin Hcl at induction of anesthesia before operation. Group
2(n=15) receive 75 mg diclofenac sodium 30 min.I.M before induction and1 microgram/Kg Fentanyl
citrate at induction of anesthesia. Then 20 ml of 0.25% Bupivacaine infiltrated in tissue under
abdominal sheath at surgical area after induction of general anesthesia with another 20 ml of 0.25%
Bupivacain was deposited in subfascial area after skin incision and. VAS (visual analog scale) score
were all recorded.
RESULT:
In control group (group1) showed mark increase in stress response to post-operative pain as evidence
by high visual analogue scale and in stress response to pain as increase in heart rate and mean arterial
pressure during 1 st 24hr post-operative. While group II patient (study group) mark decrease in postoperative pain as evidence by low VAS and insignificant change in heart rate and mean arterial blood
pressure. It shows that pre-emptive analgesia reduces severity of post-operative pain and analgesic
requirement in post-operative period.
CONCLUSION:
Our result indicates that pre-emptive analgesia is effective in reduction of post-operative period.

BACKGROUND:
Colorectal adenocarcinoma is the most common type of gastrointestinal cancers in Iraq, and
according to the Iraqi cancer registry (ICR) reports, the incidence of colorectal carcinoma was
2.99% of whole body malignancies (ICR 2010). In males, it’s the 5 th common cancer while in
females it’s the 4th most common cancer.
Her2/neu is an important oncogene in breast cancer, but its prevalence and significance in
colorectal carcinoma have been documented.
OBJECTIVE:
To determine the frequency and the pattern of Her2/neu expression in colorectal adenocarcinoma
by immunohistochemical technique and to correlate this expression with different
clinicopathological parameters.
MATERIAL AND METHOD:
Twenty five cases of colorectal adenocarcinoma were studied, these cases were diagnosed in
private laboratories in Baghdad/Iraq from November 2011 to march 2013. Clinicopathological
parameters such as age, gender, pathological diagnosis, including the tumor site, size, lymph nodes
status, grade and stage of tumor were taken from patients file. Sections of 4 µm stained by H&E
stain and immunohistochemical stained for Her2/neu.
Using infiltrative ductal carcinoma of the breast as control positive, evaluation of Her2/neu
expression by immunohistochemistry in all cases was performed.
RESULTS:
Fourteen (56%) of the cases were males, 11 (44%) case were females, with age distribution ranging
from (24-89) years, with a mean age of 56.5 years. Tumor size ranges between 2.5 -10 cm, with
mean of 6.25 cm. Seven (28%) cases were localized in the cecum, 5 (20%) from each rectum,
sigmoid and left colon, respectively and 3 (12%) involving more than one segment of the colon.
Histologically the tumor grade ranges from moderately differentiated in 23 (92%) cases and poorly
differentiated in 2 (8%) cases. Regarding pathological staging (TNM system), 5 (20%) were stage
T2, 17 (68%) were stage T3 and 3 (12%) were T4. Lymph node involvement found in 10(40%) of
the cases and distant metastasis was found in 2 (12%) cases. Her2/neu expression was present in
4(16%) cases of 25 colorectal adenocarcinoma; there was no correlation with age, sex,
histopathological grade, location, lymph nodes status and tumor invasion.
CONCLUSION:
Concerning data exists about the prevalence of her2/new expression in colorectal
adenocarcinoma, there was no significant correlation between her2/neu over expression and tumor
size, grade, localization of the primary tumor, lymph nodes status and depth of invasion.

BACKGROUND:
Immunophenotyping with monoclonal antibodies (MoAbs) directed against lymphoid-associated
antigens, immunohistochemical staining on paraffin-embedded BM biopsy material, and molecular
studies of Ig genes/T-cell receptor genes or lymphoma-associated gene translocations should be used
in the global approach to the patient with malignant lymphoma.
OBJECTIVE:
1. To determine the subtypes of non-Hodgkin lymphomas (B- or T cell) in the bone marrow using
anti-CD3, CD8 monoclonal antibodies for T-cell and anti-CD19 and CD20 for B-cells.
2. Correlation of the subtypes of NHL (B- or T cell) with the morphology and pattern of bone
marrow infiltration.
PATIENTS, MATERIALS AND METHODS:
A retrospective study, done in Al-Kadhymia teaching hospital during the period from 1/10/2010
to1/2/2011.The study consisted 26 adult patients, who were diagnosed as Non-Hodgkin lymphomas
by undergoing a BM biopsy. Immunohistochemical staining of the paraffin-embedded sections of
BM trephine biopsies was performed in all cases and used standard techniques with monoclonal antiCD8, CD20 and dual immunofluorscence-labelled CD3, and CD19 antibodies and also all stained
with Hematoxylin and Eosin (H&E) for morphologic assessment.
RESULTS:
The 26 cases of NHL comprised of 14 male (54%) and 12 female patients (46%) . The median age
was (57.32) year ranged from 27-85 years. There were 23 cases of B-cell cases (88.5%) and 3 cases
of T-cell lineage (11.5%) of all the cases. Among all the B-cell lymphomas, 15 cases showed
interstitial infiltration in the bone marrow, while among the T-cell lymphoma two cases showed
diffuse infiltration.
CONCLUSION:
1. In these 26 cases NHL patients with marrow involvement, B cell phenotype comprised 88% of
cases.
2. B-cell NHLs had predominance of interstitial infiltration in bone marrow biopsies in comparison
with the T-cell lymphoma, in which diffuse infiltration was predominant.

BACKGROUND :
Preeclampsia (PE )is a potentially life-threatening hypertensive disorder affecting_ 2-7% of all
pregnancies , It is a leading cause of maternal mortality ,and associated with high perinatal
mortality and morbidity, including intrauterine growth restriction (IUGR) and prematurity. A daily
low dose of aspirin (60-80 mg /day) may use for prevention and treatment of PE and fetal growth
retardation in pregnant women at risk.
OBJECTIVE:
To assess the influence of aspirin therapy on the histology of placenta from mothers with PE and
to correlate the findings with those from pre -eclamptic mothers but not using aspirin during their
pregnancy and with placenta from normal Pregnancies .
METHODS:
This study was carried out on one hundred twenty –pregnant women, thirty five with
uncomplicated pregnancy and eighty five mothers with PE , fifty of these hypertensive women on
aspirin therapy since first trimester.
RESULT:
It was found that mothers with pre- eclampsia either take aspirin or not had relatively smaller,
irregular placentae. Histological features of vascular insufficiency like thrombosis,
cytotrophoblastic cellular proliferation, fibrin plaque formation etc. were present in more or less
similar amount in both groups of hypertensive placentae. Babies of such mothers were mostly
small for date.
CONCLUSION :
Despite the little improvement in outcomes of the aspirin treated pregnancy, , histologic evidence
of placental pathology persisted in the majority of women with PE. so aspirin therapy is not
effective in preventing and treatment PE

BACKGROUND:
A trapped fourth ventricle is diagnosed when the
fourth ventricle is no longer communicates with
the third ventricle and the basal cisterns. The
resultant obstruction leads to persistent and
progressive dilatation of the fourth ventricle.
CASE REPORT :
This 20-year-old male known to have right sided
ventriculo-peritoneal shunt placed three years
back after the diagnosis of obstructive
hydrocephalus. On January, 2013 the patient was
presented with headache, vomiting and blurred
vision. CT scans of the brain showed welldecompressed lateral ventricles with a large and
dilatation of the fourth ventricle. The diagnosis of
trapped fourth ventricle was done and a shunt
system was placed directly in the fourth ventricle.
Postoperative period was uneventful and the
patient was discharged well.
DISCUSSION:
The concept of trapped fourth ventricle is a well
described entity. Different causes have been
postulated and different therapeutic approaches
were attempted to solve this problem.
CONCLUSION:
Direct ventriculo-peritoneal shunt in trapped
fourth ventricle can efficiently resolve this
condition.