Issue 2

Management of Retroperitoneal Soft Tissue Sarcomas

Safa M. AL-Obaidi; Alaa A. AL-Wadees; Mohammed Abd-Zaid Akool

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 166-174

Hospital , Baghdad.
*Department of surgery ,Kufa Teaching Hospital
, Najaf.

Most retroperitoneal tumors are malignant and about one third are soft tissue sarcomas. Sarcomas
are uncommon malignant tumors arising from mesenchymaltissue . Retroperitoneal sarcomas
account for approximately 10%-15% of soft tissue sarcomas and less than 1% of all malignant
neoplasms. Surgery is the only curative treatment for retroperitoneal soft tissue sarcomas.
To define the best extent of surgery that would optimize the safe margins on retroperitoneal soft
tissue sarcomas , where the recurrence of tumor greatly depends on feasibility of complete
resection and the grade of tumor.
Between June 2007 and December 2010,28 patients (female 16,male 12, mean age; 43.93 years,
range18-69 years)were evaluated for survival and response to therapy by gender, age ,preoperative
symptoms ,symptoms duration , primary or recurrent tumors , the extended of surgical resection, or
palliative procedures .Complete resection was defined as removal of gross tumor with
histologically confirmed clean resection margins.
Eighteen patients(64%) out of 28 patients under went simple surgical resection ,5
patients(28%)underwent compartmental resection (systematic resection of noninvolved contiguous
organs),1 patient (3%) underwent enucleation of tumor ,while debulking done in 4 patients (15%).
The surgical resection margin was involved only in one patient (due to tumor rupture during
resection) of those patients underwent compartmental resections, it’s was free in only (10/18,56%)
patients underwent simple resection ,while it was involved in all tumors removed with enucleation
or debulking (incomplete resection) .
The recurrence of tumor greatly depends on state of surgical margin in resected sample (pvalue=0.001


histopathological grade of tumor on the other hand also proved an important factor in the
recurrence of tumor where it was higher with high grade tumor versus low grade tumor (Pvalue=0.001

Complete compartmental surgery without tumor rupture should be performed when possible to
achieved clear margins. Wide resection lowers the local recurrence and improves survival rate.
Both the state of surgical margin and grade of tumor are the most important prognostic factors
which determine the survival rate and recurrence tumor.

Evaluation of Clinical Parameters that Predict Difficulties During Laparoscopic Cholecystectomy

Karam Kamal Younis; Layth Qassid Al-Harbawi; Omar Abbas Ashoor

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 175-180

Laparoscopic cholecystectomy(LC) may be rendered ‘difficult’ by various problems encountered
during surgery e.g accessing the peritoneal cavity, dissecting the gall bladder … etc.
To identify certain preoperative clinical parameters to predict technical difficulties during (LC) .
SETTING: Surgical wards of Al-Jamhoori Teaching Hospital between October 2009 to October 2010.
A prospective analysis of150 patients who underwent (LC). Prospective analysis of different
preoperative data including patient's age, gender, weight, height, previous abdominal surgery and
previous attack of acute cholecystitis were done. The dependent variables (outcomes) included the
duration of operation, bleeding, difficult accessing, bile leak, difficult dissection of gall bladder, and
conversion to open cholecystectomy. Surgeons who performed the operations had operative experience
of more than 50 (LC)
The difficulties were met in 57(38%) patients. The mean duration of surgery was 79·83 ± 1·30 minutes.
Factors contributed to difficult (LC) were; male gender, previous upper abdominal surgery and BMI >
Preoperative clinical patient's factors including male gender, BMI > 35 and history of previous upper
abdominal surgery are significant predictive preoperative parameters for difficult (LC). Knowledge of
these parameters preoperatively can predict difficulties during (LC).

The Effect of Perioperative Use of Prophylactic Antibiotics on Surgical Wound Infection

Ahmed Hamid Jasim; Nabeel AL-Dawoody; Tharwat I. Sulaiman

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 181-185

Surgical site infection is one of the commonest complications after surgical operations and the use
of antibiotics in preventing or reducing infection is associated with many problems.
To evaluate the use of peri- operative prophylactic antibiotics in preventing or reducing surgical
site infection in different types of operations
This prospective study was conducted on(560) patients from June 2002 to January 2007 in general
surgical department in Baghdad teaching hospital.
The patients were divided into( 3) groups according to the type of operation; clean operations
which included 200 patients, clean-contaminated operations which included 160 patients and
contaminated operations which included 200 patients) and they were further subdivided into 2
groups, group A of patients were treated with peri operative prophylactic Cefotaxime antibiotic
while the group B patients were treated with therapeutic dose of the same antibiotic for prolonged
duration (5 days).
Those patients were followed up for 4 weeks after operation and when signs of wound infection
appeared, swab for culture and sensitivity was taken to determine the type of bacteria, and effective
antibiotics against them.
Result showed that (3) patients (3%) in clean surgery developed wound infection when using
perioperative regimen as compared to( 2) patients (2%) when using therapeutic regimen. In clean
contaminated wounds infection appeared in (5) patients (5%) in patients using prophylactic or
postoperative regimen while in contaminated wounds, (11) patients (11%) developed wound
infection when using perioperative regimen as compared to( 6) patients (6%) who developed
wound infection in patients using postoperative antibiotics.
Statistically, there is little difference in effectiveness of the two regimens (A and B) in both group(
1) and( 2) operations but in the group( 3) operations, although prophylactic antibiotic regimen
reduced the infection rate to 11% but it was not as effective as the therapeutic regimen in reducing
wound infection (6%) .
Postoperative antibiotics should be resisted in clean and clean contaminated operations instead
perioperative antibiotics can be used, and prolonged postoperative antibiotics should be used
only in contaminated operations

Postoperative Pain Reduction with Bupivacaine Instillation After Laparoscopic Cholecystectomy

Sami Hasson; Firas AL Chalabi

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 186-191

Pain occurs frequently following laparoscopic cholecystectomy leading to increased patients
distress, delayed discharge, increase the need for analgesia and delayed oral intake
To evaluate the effect of bupivacaine instillation on pain relief in the early post- operative period
following laparoscopic cholecystectomy.
Eighty patients having symptomatic gall stones were included in this study. The procedure was
explained to the patients and informed consent was obtained. The patients were divided into two
groups: group (A) received 40 ml of(0.125%) bupivacaine diluted in 60 ml of isotonic saline(0.9%)
instilled in the subdiaphragmatic and subhepatic spaces, the remaining 40ml of (0.125%)
bupivacaine were used for wounds infiltration. The post operative pain was assessed by visual
analogue scale(VAS) at fixed time intervals, both patients and house officer doctor were blinded to
the group of the patients. Group (B) stood as a control group.
The two groups were comparable in age, gender, weight, and duration of operation. The male
to female ratio was (1:4), the mean age in both groups were insignificantly different, their
weights ranged from (58- 96) kg. Post operative abdominal pain was significantly lower in group A
(bupivacaine group) than group B ( control group) in the first twelve hours.
The mean abdominal pain score ranged from (3.85 to 2.55) for the bupivacaine group, and from
(6.62 to 3.16) in the control group, the p value is < 0.001which is highly significant in the first 6
hours. Group A had a lower incidence of shoulder pain in comparison with the control group
although statistically not significant.
Intraincisional infiltration with bupivacaine is a simple and feasible procedure which significantly
reduces post operative pain

Skeletal Metastasis;Distribution by Age, ,Sex,and Histological Classification(Medical city)

Abdul Ridha Kh.Jabbar

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 192-195

Skeleton is the one of the commonest sites of secondary cancer, it is seen more frequently than
all primary bone tumors together. Vertebrae, pelvis and proximal parts of long bone are more
involved by secondary metastasis. Breast cancer is the commonest cause of primary tumor
followed by Prostatic carcinoma. Despite the advances in diagnosis but still about 10 % of
cases remain as secondary with undetermined primary site.
To disclose the distribution of bone metastasis and their primary site among Iraqi patients.
102 patient were enrolled in a retrospective study conducted in medical city complex in
Baghdad/ Iraq from January 1990- July 2000.
Patient are either known to have primary malignant tumor and discovered to have secondary
metastasis to bone as part of the routine screen or development of symptoms suggestive of
bone metastasis, the other group of patients are presented with bone metastasis. All patients
are subjected to intensive medical history and proved their secondary metastasis by excisional
biopsy or fine needle aspiration with histopathological diagnosis
The mean age of our patients was 41 years, with range (2-80 years), men were commonly
involved than women, the peak incidence of metastasis was in 1991. Vertebral bodies are
commonly involved and lungs are the most common primary site
Well differentiated columnar adenocarcinoma is the commonest histopathological type of
malignant tumor metastases to bones, lungs are the most common primary site. Undetermined
primary tumors are still consist a diagnostic problem in our daily practice more cooperative
team work is needed to disclose the final diagnosis

Preoperative Prediction of Difficult Laparoscopic Cholecystectomy by Clinical Assessment and Ultrasonagraphy

Mohamed Salih Younis

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 196-201

Laparoscopic cholecystectomy(LC) has now replaced open cholecystectomy(OC) for the treatment of
gallbladder diseases. However, LC may be rendered difficult by various problems encountered during
surgery, such as difficulties in accessing the peritoneal cavity, dissecting the Calot’s triangle and gall
bladder, or extracting the excised gall bladder.
Of this prospective study: is to determine whether preoperative clinical parameter and Ultrasonagraphy
can predict difficult LC.
100 patients underwent LC in Al-Jamhuri Teaching Hospital, all had gallstone disease. Prospective
analyses of different preoperative clinical and ultrasonic parameters contributing to difficult LC were
performed. These included: age, gender, BMI (Body Mass Index), previous upper abdominal surgery,
previous attack of acute cholecystitis , gall bladders size , gall stones size and numbers. The outcomes
included the following operative parameters: access to peritoneal cavity, adhesion and difficult
dissection, bleeding during surgery, bile leak, and conversion to OC.
Of 100 patients with LC 41 patients (41%) developed difficulties during operation .Factors contributed
to difficult LC were male sex, previous upper abdominal surgery ,previous attack of acute cholecystitis
, BMI more than 35 and gall stones that were more than (1 cm) in diameters . The most common type
of difficulties was intraoperative bile leak (14%) and the least frequent difficulty was conversion to OC
Clinical and ultrasonographic findings can help to predict difficult LC .This information may be useful
to both the patients and surgeons in being better prepared for the intra-operative risk including
conversion to OC

Comparison of the Hemodynamic & Respiratory Parameters between Smokers & Non Smokers in Lower Abdominal Surgery Under General Anesthesia

Iyad Abbas Salman; Musrey Younis Jahn

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 202-207

Smoking is a very widespread habit , it had been proved to affect adversely on many systems of
the body especially the cardiovascular (CVS) & the respiratory system, and such effects would
be exaggerated perioperatively because of the effect of general anesthesia (GA) especially when
there is no any period of abstinence from smoking (as when occurred during emergency
To assess the hemodynamic & respiratory effects of smoking perioperatively in patients
undergoing emergency lower abdominal operations.
A prospective case control study carried on 80 patients in Baghdad teaching hospital/Medical
city / Baghdad / Iraq, from September 2011 to March 2012, the 80 patients have been allocated
into 2 groups, (each of 40 patients): group 1 who were non smoker patients, & group 2 the
smoker patients.
The 2 groups were undergone emergency lower abdominal surgery under GA, all the patients
received similar pre. & intraoperative managements. Pulse rate (PR), systolic blood pressure
(BPsys), diastolic blood pressure (BPdias),oxygene saturation (SPO2), and airway pressure
(Paw) were monitored with the standard non invasive technique, at the baseline period
(preoperative); immediate postintubation; 10, 20, 30, & 40 minutes intraoperatively; immediate
postextubation; & 10 minutes in the recovery period.
Regarding the pulse rate, there were no statistically significant variations between the 2 groups
apart from the immediate postextubation period (105 ± 6.95 in smokers vs 100.3 ± 8.3 in non
Regarding the systolic blood pressure, there was statistically significant increase in the systolic
BP especially at the immediate postintubation period in smoker patients
Regarding the diastolic BP, apart from the immediate postextubation period ,there was
significant increase in the diastolic BP between the 2 groups especially at the immediate
Regarding the SPO2%, there were no statistically significant reduction in the SPO2 readings
between the 2 groups apart from the intraoperative period
Regarding the P airway , there were no significant increase in the P airway perioperatively
between the 2 groups
There were statistically significant CVS derangements in the smoker group versus the non
smokers especially around intubation period.

Angiotensin Converting Enzyme Inhibitors, to Continue or Discontinue on the Morning Day of Surgery

Sabah Noori Al-saad; Arkan Muhammed Mahdi

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 208-212

Angiotensin converting enzyme inhibitors(ACEI) play a pivotal role in the management of
. whether to continue or discontinue them before surgery is an everyday encountered
question of both surgeon & patient, this issue is continuously submitting to debate & controversy.
To compare between the incidence of intra-operative hypotension in hypertensive patients who
continue to take ACEI. & those who discontinue, & are undergoing general anesthesia for non-cardiac
A comparative study consist of 40 patients presented to the Medical City, Baghdad Teaching Hospital
& Surgical specialty Hospital between July 2011,to March 2012.the age of patients range from 38-70
years old, they were 10 (25 %) men and 30 (75 %) women , they were divided into two groups;
according to mode of medication, cases ( who were continued taking medication ) and control (who
were discontinued medication),twenty patient each, all patients underwent different surgical
interventions under general anesthesia, they were studied & monitored intra-operatively regarding
development of hypotension, this was done at time interval of 5 minutes & at starting point prior to
induction of general anesthesia until 20 minutes after.
By comparing the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) in between
both groups of patients, those who were continued ACEI (group A) or those who were
discontinued(group B), it had been found that no significant differences in mean SBP neither preoperatively




or discontinuing ACEI before non-cardiac surgery under general anesthesia has no
statistical significance regarding concern of developing intra-operative hypotension.

Epidemiological Study of Measles in Al- Kadhimiyia Teaching Hospital

Lamia Abdul Karim; Ali Kadhim Al-Husainawi

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 213-222

Measles is a highly communicable disease caused by the measles virus. The disease is
marked by prodromal fever, conj unctivitis, coryza, cough, and the pathognomonic koplik
spots followed by an erythematous maculopapular rash. Infection confers lifelong immunity.
Find out the frequency of measles in the hospital admitted cases in chi l dr en ≤ 12
year s accor di ng t o t he vaccination and nutritional status,The causes of non-vaccination and
the vaccine efficiency in preventing measles.The incidence of measles in the exclusively breast
fed infants.The presenting signs and symptoms, commonest complications, investigations and the
A prospective study was performed from the 1
of January to the 1
known as rubeola and is marked by prodromal
fever, conjunctivitis, coryza, cough, and
pathognomonic Koplik spots, followed by an
erythematous maculopapular rash on the 3rd to 7
day. Infection confers life-long immunity.

of May in the year 2009, in
Al-Kadhimiyia Teaching Hospital.The data was collected through a questionnaire asked
directly to the parents, and all the patients were systemically examined and followed up clinically
until they discharged home or unfortunately died.The collected data was analyzed and adjusted
using the SPSS version 10 statistical programs.
The incidence of measles was (44.29 %).Most of cases were living in crowded houses, all
patients had positive history of contact, mostly during a visit to a medical health facility (49.3
%).All age groups were affected by measles, mostly in the 1
(27 %) and the
nd (19 %) years
of life.Higher incidence was reported in males (53.5 %).Most of the cases were nonvaccinated

(86.25 %) with non-vaccinated mothers as well (85.25 %). Nineteen percent of
the cases were malnourished. The incidence was lowest in the exclusively breast fed infants (1.5
Measles mostly presented with fever for ≥ 3 days (100 %), rash (100 %) and conjunctivitis
(98.25 %).The commonest complications were pneumonia (62.75 %), diarrhea (40.25 %).
The majority of patients who had developed convulsions had normal CSF analysis results (76.7
%). CXR reported pneumonic consolidation in (62.75 %) of the patients. Ninety percent of cases
were discharged home and (10 %) died.
Measles is higher in the crowded places, in infants and toddlers, in males, in the nonvaccinated,

and less in the exclusively breast fed infants. It is more severe in the
malnourished patients. Vaccination is the most important preventive measure against measles.
Measles mostly present with fever, maculopapular rash, and conjunctivitis, with the most
common complications are pneumonia, diarrhea, and encephalitis.
The disease usually has no or little effect on the blood counts and CSF analyses, and CXR
document pneumonic consolidation in the majority of cases.
Measles is still a serious disease with high fatality rat

Follow Up of Sixty Patients with Chronic Lymphocytic Leukaemia

Alaadin Sahham Naj; Bassam Francis Metti; Fouad M. AL-Kasab

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 223-229

Chronic lymphocytic leukemia(CLL) is heterogeneous in its clinical course and typically
diagnosed when patients presented with symptoms of lymphadenopathy, cytopenia ,constitutional
symptoms or infection. Now 50% of patients with CLL are likely to be diagnosed when an elevated
lymphocyte count is discovered incidentally .
Description of various presentation in adult patients with CLL, complications that happened
during the course of their disease, cause of death and overall survival in these patients.
Sixty Iraqi adult patients with CLL were studied retrospectively and prospectively. These patients
were assessed clinically and stratified with Rai staging, with follow up for any complications that
occurred during their course of disease from time of diagnoses till last visit or death.
In this study, the age group more than fifty years form 50(83.3%) patients and those less than fifty
form 10(16.6%) patients. The commonest clinical feature reported was constitutional symptoms in
19(31.6%)patient. Rai staging of these patients found to be that most of patients intermediate stage
II 22(36%) and advanced stage III, IV in 34(56.6%)
Regular follow up of these patients revealed that autoimmune disorder occur in 6(10%) patients, in
form of autoimmune hemolytic anemia (AIHA),pure red cell aplasia (PRCA)and immune
thrmbocytopenia (ITP).The increase susceptibility to infection by different viral , bacterial and
parasitic infection was noticed in these patients during their course of illness. Death in these
patients was due to infection with HBV and liver failure in 2(3%)patients, obstructive jaundice and
hepatic encephalopathy in one(1.6%)patients, sepsis in 4(6.6%), bleeding in one (2.04%) ,renal
failure in two patients (1.6%),chronic sinusitis with fungal infection and renal failure in one
(1.6%)patient ,Richeters transformation and disease progression in 7(11.6%) or due to co morbid
illness (stroke, ischemic heart disease, heart failure ) in 3(5%) patients. The overall survival for
these patients within five years was 50% .
Constitutional symptoms was the commonest presentation of CLL Iraqi patients. The indolent
course of the disease in CLL patients, still can be interrupted by different complications including
infection, autoimmune disorder, and malignancy.

The Effect of Cotton Wool Dust on Peak Flow Meter (PEF)of Textile Factory Workers in Mosul

Kassim .M. Sultan; Muhammed .W.AL.Obaidy; Aziz Mohammed

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 230-236

Byssinosis is a disease caused by long exposure to cotton, hamp, and flax dust, it differs from occupational
asthma, it needs along period of exposure to develop and the worker gets adaptation on subsequent days after
Monday chest tightness. The over all prevalence of byssinosis was 22.4%.Byssinosis needs at least 10 years to develop,
the prevalence and severity increased with increasing duration of exposure to cotton dust. processing of cotton is
more harmful to lungs, and this is due probably to high dust concentration, or the dust contains toxins
and other organic substances which decrease in later manipulations.
To find out the prevalence of byssinosis among textile factory workers in mousel.
To through alight on the relationship between smoking and byssinosis among workers exposed to
cotton wool dust. the relationship between duration of working in a textile factory and occurrence
of byssinosis
Two hundred and fifty Mosul Textile factory male workers , occupationally exposed to cotton
dust, aged (22-65) years were randomly selected and were interviewed to get information about
age, work duration, smoking habit, and about chronic cough, phlegm, wheeze and chest tightness,
and workers were examined clinically, and special considerations attended to the chest. The
workers involved in this study were in good health at the time of engagement to this work, and any
worker with bronchial asthma, or other chest diseases were excluded. by history .Peaked
expiratory flow (PEF) was carried out for all 250 workers by Right's Peak flow meter
(W18416.Harlow, England).
All of the workers were male their age ranged 22-65 years with mean age of 45.3 years, in those
between 31-40 years the incidence was 10.8%, this increased to 49.3% in those whose age was
over 51 years. The mean work duration was 18.2 years, ranged (2-44) years. The prevalence was
12.6% in age groups 10-19 year work duration, 47.2% in 20-29 years, and 49.2% in those over 30
year work duration. In age group 10-19 years work duration moderate cases of byssinosis was
4.7% and no any sever case and mean PEF 106%, while in age group over 30 year work duration
there was 33.3% moderate and 7.9% sever cases of byssinosis and mean PEF 94.9%.increased
prevalence and severity of byssinosis in sections where the dust concentration was high. In the
weaving room 12%, were byssinotic, where the dust concentration was lowest, 25%, in spinning
room where the dust concentration was higher, while in ginning room where the dust concentration
is highest the prevalence was 41.8%. .
We have shown that the prevalence of byssinosis is still high in MousalTexitle factory- Iraq. It is
statistically estimated that the prevalence of byssinosis after 8 years will be 35.2%, the reason for
this may be attributed to bad occupational safety measures..

The Impact of Duration of Neutropenia in the Immunocompromised Host

Noaman Abdulateef Abdulrazzaq; Saad Shawqi Ebada

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 237-243

Infection is a common cause of morbidity and
mortality in immunocompromised patients for

*Central Public Health Laboratory-Ministry of
**Dep.College of Medicine University of
Baghdad .
whom diagnosis and management require
scrupulous attention and continuing awareness of
the microorganisms causing infection in a
particular environment in different groups of
patients , most are caused by recognized
pathogen, although uncommon,some times


Patients with neutropenia can be at low-or high-risk according to the duration of neutropenia, its
differential count, the ANC (absolute neutrophil count) in addition to search for any causative
agents to improve the diagnostic and therapeutic outcome.
This study focuses on the clinical and microbiological data in relation to the duration of
neutropenia in a sample of immunocompromised Iraqi patients due to leukemia and aplastic
150 patients presented with pyrexia, marrow failure from oncology unit of the 7
floor of Medical
City Hospital, National Center of Hematology-Iraq , Institute and Hospital of radiotherapy and
nuclear medicine studied between 2008-2009 ,classified into three groups, fifty for each, with a
plastic anemia, acute lymphoblastic leukemia(ALL), acute myelogenous leukemia(AML),all were
investigated for WBC count, differential,ANC,Hb,Pcv,platelet count, RBC,Peripheral blood film
for blast cells,ESR, specifically in those complaining from pyrexia of unknown origin. direct
examination ,culture and sensitivity of the urine,stool,body fluids, sputum ,blood, tonsil and skin
swab, Widal, rose Bengal tests, besides temperature recording was done for all patients with
known site of infection.
Neutropenia of a plastic anemia 5-70 days with a mean of 25 days is associated with a higher risk
of infection particularly by the gram-negative enterobacter ,but with a mortality rate of 26%,while
those suffered from ALL with a range of 11-40 day and a mean values of 16 days with a less
mortality rate 22%.Unfortunatelly AML although gets a range of 7-35 day and a mean values 18
day and short lived neutropenia yet it was significantly have a higher mortality rate 52%
presumably due to the combined effect of low neutropil count and chemo radiotherapy .However
sever neutropenia (ANC < 500) is only found in 10 AA,6 AML,and 4 ALL patients, and moderate
neutropenia (500 ≤ ANC < 1000) were explored in 7 AA,4 AML,10 ALL.
The microbiological investigation shows that gram negative microorganism especially E.coli is
positive in 19 different samples followed by Klebsiella 12 positive sample, then monilia takes
place12 cases, followed by the remaining microorganisms.
Lastly pyrexia of unknown origin were found to be the top problem facing immunocompromised
patients with 20% AA,34%ALL,30%AML followed by chest infection
16%AA,22%ALL,15%AML, and then urinary tract infection17%AA,17%ALL,10%AML
followed by other types of infections.
Neutropenia is prolonged in a plastic anemia compared to acute leukemia with the risk of
infection is directly related to it.G(-ve) enterobacter particularly E-coli is the commonest pathogen

Post Hair Epilation Acneiform Eruption Among Females

Khalifa E. Sharquie; Haider R. Al-Hamami; Inas K. Sharquie; Adil A. Noaimi; Huthaiffa M. Al-Karawy

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 244-246

Acneiform eruptions are common and important variants of acne vulgaris, there are many
examples of acneiform eruptions like steroid acne and pityrosporum folliculitis.
To evaluate the acneiform eruption that follows hair epilation.
This case-series study was conducted in Department of Dermatology and Venereology, Baghdad
Teaching Hospital during the period from January 2005 through July 2006. Forty females were
included in this work, history was taken from each patient and all were clinically examined
regarding all relevant points to this condition. Swabs and cultures from rash were carried out on
11 patients using blood, chocolate, and McConky agar as culture media.
The ages of patients ranged from14-40 years with a mean ± SD of 20.85 ± 5.52 years. History of
acne vulgaris was positive in 32 (80%) patients, and it was mild acne, resolved before the onset
of hair epilation acne. Method of hair epilation was threading and sugaring.The time interval
between hair epilation and rash appearance was 1-21 days with a mean ± SD of 4.48 ± 3.36 days.
Itching was the commonest symptom complained by 18(45%) patients.The lesions morphology
was mainly monomorphous erythematous papules surmounted by tiny pustules. Swabs and
cultures revealed no pathogenic bacteria.
Hair epilation by threading and sugaring is a common cause of monomorphous acneiform
eruption and might be an important triggering and exacerbating factor for acne vulgaris in Iraqi

Treatment of Tinea Corporis by Topical 10% Zinc Sulfate Solution

Khalifa E. Sharquie; Adil A. Noaimi; Sarmad A. Al-Hashimy; Iqbal G. F. Al-Tereihi

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 247-250


Tinea corporis is a dermatophyte infection of the glabrous skin. Multiple modalities of therapy have
been used in the treatment of tinea corporis including both systemic and topical agents, such as
imidazols, triazols, allylamines, ciclopirox and griseofulvin.
To evaluate the efficacy and safety of topical 10% zinc sulfate solution in the treatment of tinea
corporis and tap water as placebo controlled in treatment of tinea corporis.
This opened labeled blind-therapeutic trial done in the Department of Dermatology -Baghdad
Teaching Hospital, during October 2004 – March 2006.It consisted from 63 patients with tinea
corporis, 33 patients treated with 10% zinc sulfate (Group A) and 30 patients received distilled water
as the placebo-control group (Group B).
Full history and clinical examinations were done for all patients including all demographic aspects
related to the disease.
Every patient was instructed to apply treatment twice daily and to be seen every 3 weeks for
2months. All patients were assessed clinically and by skin scraping test before, during and after
Sixty three patients with tinea corporis met the inclusion criteria and enrolled in this study. Sixty
patients completed the study, three patients defaulted from the study in Group A . In Group A 30
patients received topical 10% zinc sulfate solution twice daily for two months, 17 (56.7%) females
and 13 (43.3%) male patients. Their ages ranged from 4-64 (27.87+17.68) years, while the duration
of the disease ranged from 1-13 (3.7 + 3.249) weeks. Complete cure response was observed in 13
(43.33%) patients, partial response in 7 (23.34%) patients and no response in 10 (33.33%) patients
while in in Group B, 30 patients received distilled water twice daily for two months as placebocontrol


+ 15.66) years, and the duration of the disease ranged from 1-30 (7.48+ 6.98) weeks. The
clinical response was two (6.67 %) patients with partial improvement and 28 (93.33%) patients with
no improvement.
No side effects reported apart from mild irritation in the beginning of treatment which resolved soon
after continuation of therapy that did not require stopping the treatment.
Topical 10% zinc sulfate solution is a new effective, safe and non costly formulation in the treatment
of tinea corporis but it is slow in clearance of the lesions and higher concentrations of zinc sulfate
like 20% might increase the effectiveness of the drug and shorten the duration of therapy

Efficacy and Safety of Topical Podophyllin 5% Ointment in Patients with Mild Plaque-Type Psoriasis

Khalifa E.Sharquie; Adil A.Noaimi; Wesal K. Al-Janabi

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 251-258

Psoriasis is a common chronic condition of the skin that is resistant to many therapies. There is a
need for the development of novel non-steroidal topical drugs for the treatment of psoriasis.
To assess the efficacy and safety of topical podophyllin 5% ointment in patients with mild plaque-
type psoriasis.
Sixty two patients with mild plaque-type psoriasis were enrolled in this study. They were divided
into 3 groups: GroupA (21patients)were treated with podophyllin 5% ointment every other day,
while Group B(20patients)were treated with clobetasol propionate 0.05%ointment twice daily and
21 patients in Group C were treated with Vaseline twice daily for 8 weeks as a control group.
Efficacy was evaluated every 2 weeks for 8weeks using Psoriasis Area and Severity Index (PASI)
score and relapse was recorded after cessation of treatment in those patients who achieved good
response during 8 weeks follow up period.
A total of 62patients were 44(70.9%) males and 18(29.0%) females, with: male: female ratio 2.3:1.
Their ages ranged from 18-65 (37.5±12.9) years. Their baseline PASI score ranged from 1.29(5.2±2.4).



A(66.3±20.7) and Group B(68.1±34.2) treated patients, P-value =0.831 and both of them
were statistically significant higher PASI reduction than patients with Group C,34.1±28.8, P-value
=<0.001.Regarding the percentage of patients who achieved good response, there was no
statistically significant difference between Group Aand Group B, 95.3% versus 70% ( Pvalue=0.083)

and both of them achieved a statistically significant higher percentage of patients
with good response than Group C,47.6%, P-value=<0.001. Although the percentage of patients
with complete clearance (PASI≥90%) in the Group Awas much less, 9.5%, than that of Group B,
65% (statistically significant, P-value=< 0.001), the total relapse rate during 8 weeks follow up was
much lower among Group Apatients, 25% versus 70%, P-value=0.043.On the other hand no
complete clearance was achieved in the Group Cand their relapse rate was 80%.
Regarding side effects: Group A, 9.5% of patients developed hypopigmentation, Group B, 10% of
patients developed pyoderma and Group C, no side effects were reported. There was no statistically
significant difference among the three groups regarding the frequency of side effects (P = 0.355).
Podophyllin 5% ointment on every other day regimen was as effective as clobetasole 0.05%
ointment twice daily at the end of 8 weeks treatment with no side effects and with a much lower
relapse rate.

Medico-Legal Comparative Study Between Traumatic and Spontaneous Intracerebral Hemorrhage

Yasser Salem Selman. Al-Yessary; Nabeel Ghazi Hashim Al-Khateeb; Ahmed Samir Al-Naaimi

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 259-267


Intracerebral hemorrhage may be pathological or
traumatic in nature. It may be primary or
Traumatic intracerebral hemorrhage (TICH) is a subtype of intracranial hemorrhage that occurs
within the brain tissue itself and lead to displacement or destruction of brain tissue with high rate.
Spontaneous intracerebral hemorrhage (SICH) is defined as a blood clot that arises in the brain
parenchyma in the absence of trauma or surgery.
The aim of this study is to determine the frequency of fatal traumatic and spontaneous intracerebral
hemorrhage, and to differentiate between them in postmortem examination.
This cross-sectional study is performed in the medico-legal institute of Baghdad for (6) months
duration from (1-10-2011) to (1-4-2012). Complete medico-legal history was obtained, and full
proper autopsy including external and internal examination of all corpuses was performed specially
the head.
The study included (38) cases of intracerebral hemorrhage; (27) of them were (TICH). Their ages
ranged between (5 –65) years, and (11) of them were (SICH) with an age ranging between (15 –75)
years. Traumatic group was associated with male preponderance and younger age, while
spontaneous group were females and older age. The most common cause of head injuries in the
traumatic group was "missiles" followed by road traffic accidents. Comminuted fractures were the
most common type of skull fracture. Brain laceration and contusion were the two most frequently
observed associated lesions in the traumatic cases. The "intraventricular"
Site was the most frequent in traumatic group, while the "Basal ganglia" was the most frequent in
the spontaneous group. The anterior cerebral artery was the most frequently affected artery in
traumatic group, while the middle cerebral artery was the most frequently affected artery in
spontaneous group.
we identified seven basic rules that can be used during autopsy examination in all cases of
intracerebral hemorrhage to differentiate easily between traumatic and spontaneous intracerebral

A Prospective Study of Gestational Trophoblastic Disease in Al-Mosul City

Zhraa Abd-Alkader Taboo

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 268-276

Gestational trophoblastic tumors comprise a wide spectrum of neoplastic disorders that arise from
placental trophoblastic epithelium after abnormal fertilization which is characterized by
trophoblastic hyperplasia and overgrowth of placental villi. There are several histologically distinct
types of gestational trophoblastic diseases GTD: hydatiform mole (complete or partial),
persistant/invasive gestational trophoblastic neoplasia (GTN), choriocarcinoma and placenta site
trophoblastic tumors.
Of the present study is to determine the incidence, clinical presentation and some of its relevant
factors among women admitted to Al-Batool Hospital in Mosul- Iraq.
The study was conducted in Al-Batool Hospital, Department of Gynecology and Obstetrics, Iraq,
Mosul city, from April 2009 to January 2011 as prospective study 9500 patients were analyzed
regarding their history, clinical examination, investigations, risk factor.
During the analysis, the peak incidence of age is between 21 – 25 years (31.2%). The most
common clinical presentation bleeding per vaginal (100%). The peak incidence of the disease is
with para two (36%). Complete hydatidiform mole forming (80%). Partial hydatidiform mole
forming (18.4%). Invasive mole forming (1.6%). The mean level of B-hCGin partial mole before
evacuation is between 3000-4000 mIU/ml. the mean level of B-hCG in complete mole before
evacuation is between 7000-10000 mIU/ml.
Frequency of GTD was higher compared to national and international studies. The disease was
common in young ages, low para and grand multiparous women. Hydatidiform mole was the
commonest type of trophoblastic disease in these patients. Most common presenting complaint was
bleeding per vagina followed by pain in lower abdomen. It appears that the ultrasound is
moderately sensitive in the diagnosis of hydatiform mole pregnancy

Presentation and Management Outcome of Eclampsia at AlElwiya Teaching Hospital

Thikra madlol; Samar Sarsam; Inteasar Twaigery; Yousif Abdul Raheem

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 277-281

Eclampsia is a life-threatening complication of pregnancy for both the baby and the mother. Research is
underway to understand this complex condition and to improve the treatments that are currently used to
control it as it is a preventable complication of pre-eclampsia.
The study reviews the cases of eclampsia managed at Elwiya teaching Hospital with respect to
incidence, management, maternal and perinatal outcome.
This prospective observational study was carried out in the department of Obstetrics and Gynaecology
at Elwiya Teaching Hospital – Baghdad-Iraq. Fifty two cases of eclamptic fits were dealt with from the
of January till the 31
of December 2008. Pregnant patients with other convulsive disorders and
more than 7 days postpartum were excluded from the study. All the patients included were evaluated by
detailed history (taken from the attendants). Management was according to basic protocol for
eclampsia; stabilization of patients, anticonvulsive therapy Magnesium sulfate, phenytoin and/or
diazepam and early delivery. A team of specialists and trained nurses were needed in the intensive care
unit to deal with eclamptic mothers.
During the year 2008, total number of deliveries from the 1
Eclampsia is one of the fatal complications of preeclampsia

which is a multisystem disorder; it
presents a challenge to obstetricians and other
physicians. Eclampsia is defined as seizure activity
unrelated to other cerebral conditions in a pregnant
woman with pre-eclampsia. The condition was
known to the ancient Greeks, who named it
eclampsia. It has been prevalent since the time of
Hippocrates; it remains an important cause of
maternal mortality throughout the world,
accounting for about 50000 deaths worldwide.

Department of Obstetrics and Gynecology at
Elwiya Teaching Hospital – Baghdad .

of January till the 31
An eclamptic seizure occurs in 0.5% of mildly preeclamptic

pregnancies and 2% of severe preeclamptics.
of December was
12154, of these patients 52 presented with eclamptic fit with incidence rate of 4.28 per 1000 deliveries.
The distribution of cases regarding the seasons was more in winter. 35 patients (67.31%) had poor
antenatal care, 17 (32.69%) had good antenatal care. Four patients had history of eclampsia in their
previous pregnancies. All the patients gave history of imminent eclampsia; two of them had blindness
also; albumin in urine was negative in two cases only. Serious maternal complications occurred in
28(53.84%) cases. Eight of the neonates died due to severe RDS.
Eclampsia is still present and common in our locality; we need better antenatal care to predict pregnant
ladies liable to develop eclamptic fit in order to decrease the incidence of eclampsia complicating

The Efficacy of the Antimuscarinic Drug Oxybutynin in the Treatment Women with Overactive Bladder (OAB) Symptoms

Jassim Mohammad Alkhazraji; Ban Dawood Mahmood

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 282-287

Overactive bladder is a symptom based
syndrome and defined by the International
Continence Society (ICS) as urgency, with or
without urgency incontinence, usually with
frequency and nocturia, if there is no proven
infection or other obvious pathology

* Department of Urology, Al-Karama Teaching
Hospital; Baghdad.
** Department of Gynecology and Obstetrics,
Ibn Al-Baladi Hospital; Baghdad.

Overactive bladder (OAB) is a symptom based syndrome. These symptoms include: urgency, with
or without urgency incontinence, usually with frequency and nocturia with no proven infection or
other pathology. It is encountered in women visiting urodynamic units as part of mixed urinary
incontinence (MUI). It greatly affects physical and social activities. Incontinence is often the key
symptom for the assessment of OAB symptoms and the decision to treat patients. Antimuscarinic
drugs are the main agents used to treat this condition. Oxybutynin (immediate-release) 5 mg orally
is the main available form in our clinical practice.
The objective of this study is to assess the efficacy of Oxybutynin immediate-release (OXY-IR) 5
mg oral tablets, in the treatment of women with overactive bladder, i.e. reduction in episodes of
urge incontinence, total incontinence, and micturition frequency.
Twenty-five patients, age range from 18-75 years, diagnosed as having overactive bladder
symptoms were treated with Oxybutynin immediate-release (IR) 5 mg tablets 2-3 times daily for 8
weeks period. Homma OAB symptom score system was used for assessment of treatment efficacy.
Cystometry was done in all patients to look for detrusor overactivity.
After Oxybutynin treatments, all the parameters in micturition patterns improved significantly:
frequency, nocturia, urgency (p value < 0.005). Homma overactive bladder symptoms scores also
improved following the treatment (p value <0.001). Cystometric examination revealed the presence
of detrusor overactivity in 20 of the 25 (80%) patients at presentation. This was reduced to 4/25
(16%) following treatment. About two-thirds (64%) of the patients reported good to great benefit
from the treatment and had a positive effect on their life concerning physical and social activity,
sleep and feeling of well-being.
The selective antimuscarinic agent Oxybutynin (OXY-IR) 5 mg 2-3 times orally is effective in
treating overactive bladder symptoms in these women by reducing incontinence attacks, urgency,
micturition times and nocturia; consequently, it improves their life quality. We recommend
devising a score system for OAB suiting Iraqi patients

Comparison of Rate of Caesarean Section between Governmatal and Private Hospitals in Baghdad City

Majida Mustafa Al-Naimy; Batool A. Gh. Yassin; Hassan H. B. AL-Kazzaz

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 288-295

Rising rates of caesarean section (CS) is a worldwide concern.
Evaluating rate and indications of CS at both public and private hospital in Baghdad.
A review of all (1354) records of CS patients during January 2009 (552 public, 802 private
hospitals) was performed.
Rate of CS was higher in private (59.2%) hospital and among mothers aged 25-29 years. Younger
patients and elective CS were higher among private patients, emergency CS was higher among
public patients. Most CS was performed in term pregnancy, longitudinal lie in both. The most
frequent indications were pervious scar (previous CS) and fetal distress in both sectors,
malpresentation in the public and failure to progress in the private hospital. Maternal request was
found only in the private.
According to the accepted rates of CS adopted by the World Health Organization (WHO) (5% 15%);

establishing audit committee, good training with second
opinion strategy are vital to reduce i

Localization of Human Cytomegalovirus- Late Gene DNA, Expression of P53 Gene and CD8-Tumor Infiltrating Lymphocytes in Oral Squamous Cell Carcinoma.

Saad Hasan Mohammed Ali; Majed Mohammed Mahmood Al Jewari; Noor Al Huda Ali A.H. Saaed

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 296-305

Molecular DNA hybridization has confirmed an association of CMV infection with a variety of oral
cancers. While cell mediated immunity is most important in controlling primary or reactivated CMV
infection, this virus has one of most effective strategies in oral carcinogenesis via impairment of
structure and function of P53 protein by interaction with viraloncoproteins.
1.To determine the percentage of CMV-infected oral squamous cell carcinoma tissue specimens; 2.
To evaluate the histopathological impact of the expression of mutated p53 tumor suppressor gene on
CMV- related, as well as CMV-non-infected oral cancer; and 3.To through a light on some
immunological microenvironment of OSCC,by assessing CD8-positive tumorinfiltrating cytotoxicT-
This study was designed as retrospective research. A total number of seventy (70) formalin-fixed
paraffin-embedded oral tissues were collected; 60 patients with oral squamous cell carcinoma, and 10
individuals with apparently-healthy oral tissues. The molecular methods for CMV DNA detection
was performed by sensitive version of in situ hybridization, whereas the phenotype of cell surface
antigen marker, namely CD8+ marker of tumor infiltrating lymphocytes and TP53 protein were
detected via relevant immunohistochemical methods.
Well differentiated grade constituted 81.7% of oral squamous cell carcinoma. Positive in situ
hybridization reactions for CMV-DNA were observed in 43.3% of the total screened tissues. Thirtythree

out of sixty (55%) oral squamous cell carcinoma showed positive immunohistochemical
reactions indicating P53 over-expression, and 18.3% showed presence of CD8-positive tumor
infiltrating lymphocytes. None of those control group showed positive reaction for CMV-DNA, p53,
or CD8 marker.
The detection of high percentage of cytomegalovirus-DNA in OSCC could mark for a parentral way
of spreading of such important and well-known sexually transmitted infection among Iraqi general
population.The obvious high percentage of mutated p53 over-expression indicates for an important
role of such genetic events in the oral carcinogenesis.A little role for CD8-positive tumor infiltrating
lymphocytes could be played in the immunological microenvironment of OSCC

Occurrence of CTX-M-I Type β-lactamases Gene in Certain Gram Negative Bacteria

Ibtesam Ghadban Auda; Sana; a Noori Hussein Al-Kakei; Saad L. Hamed

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 306-311

The CTX-M-type β-lactamases represent a group with a typical extended-spectrum β-lactamase
(ESBL)-resistance phenotype. These enzymes, encoded by transferable plasmids. They have a
preferential hydrolysis of Cefotaxime over Ceftazidime. The CTX-M-type β-lactamases have been
described in species of Enterobacteriaceae and Pseudomonas aeruginosa.
This study was designed to investigate of the occurrence of CTX-M-I type in some Gram negative
bacteria species isolated from clinical cases of in Iraq.
A group of Gram negative bacteria were isolated from different sources.Plasmid DNA extraction,
and electrophoresis were performed. Using specific primers, CTX-M-I enzyme genes were
amplified by PCR.
Plasmid profile of the tested isolates reveals the presence of relatively large plasmids, their Wight
was more than 10 kb some isolates posses’ 3-4 kb plasmids. The results of PCR amplification
showed the presence of CTX-I genes. All isolates of Salmonella enterica serovar Typhimurium
(100%) are negative for CTX-M-I gene as well as most of P. aeruginosa isolates (86.7%). In
contrast, all of E. coli (100%) and most of Proteus Spp isolates were positive for CTX-M-I gene.
CTX-M genes are predominant in E.coli followed by Proteus Spp. while Salmonella enterica
serovar Typhimurium and P. aeruginosa isolates showed low incidence of blaCTX-M genes
occurrence. The alarming situation with dissemination of CTX-M producing isolates highlights the
need for their epidemiological monitoring and prudent use of antimicrobial agents

Delay Neurological Development in Two Children with Megaloblastic Anemia

Abbas A. Alrabaty; Azhar H.ALsaqy

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 312-314

Vitamin B12 deficiency in infants often produces
haematological and neurological deficits, including
macrocytic anaemia ,neurodevelopmental delay or
regression, irritability, weakness ,hypotonia ,
ataxia, apathy, tremor, and seizures. The diagnosis
of vitamin B12 deficiency can be difficult when
the typical macrocytic anaemia is absent

Infantile vitamin B-12 deficiency with ineffective
haematopoiesis and degeneration of nervous tissue
has been reported in breast fed infants of mothers
on strict vegetarian diets
2) )
Adults may tolerate
vitamin B-12 deficient diets for many years
without apparent symptoms due to their
endogenous stores. In contrast, infants have very
limited hepatic reserves of vitamin B-12 and so
may develop symptoms of deficiency within

. we report two cases in which they were
diagnosed as cerebral palsy in early life. first case
was 9 month old female baby presented with
pallor for last 3 months of age, floppiness ,regress
of acquired millstone ,exclusive breast feed for a
vegan mother ,diagnosed as megaloblastic anemia
second case was 16 months old male baby
presented with apathiness , he was exclusively
breast feed till this age with minimum
complementary food.
KEY WORDS : megloblstic anemia ,breast feed

Dermoid Cyst of the Spermatic Cord : a Rare Case of Benign Inguinal Lump

Mohammed Hillu Surriah; Quttiba Abd-ul-Razaq Muneer

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 315-320

Dermoid cyst of the spermatic cord is an extremely
rare pathological state seen at the general surgery
and the urological clinic. We present a case of a
19-year old male who presented with a painless
left groin lump, irreducible, and no cough impulse
from childhood, both testes presented in the
scrotum and normal in size and shape.
From the history, physical examination, ultrasound
examination, we thought it was a lipoma , a
hydrocele of the spermatic cord, or irreducible
inguinal hernia.
During the operation , suspicion of a dermoid cyst
of spermatic cord occurred from a sebum and hair
which discharged from the cyst during dissection
of the cyst from spermatic cord.
The final histopathological analysis established the
diagnosis of dermoid cyst of spermatic cord.