Volume 18, Issue 1, Winter 2019, Page 1-75

Outcomes of Gamma Knife Surgery in the Treatment of Patients with Metastatic Brain Tumors

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 1-9

Cerebral metastases are by far the most common intracranial tumors in adults. gamma knife
radiosurgery has arguably been the most important advancement in the management of metastatic
brain tumors since the 1980s.
To evaluate the effectiveness of gamma knife radiosurgery as a treatment of metastatic brain
This is a prospective study (the first trial in Iraq) of 27 patients (42 tumors) of brain metastasis
between March 2016 and October 2017. Imaging follow up done in 6 months and 12 months,
clinical follow up done in 3 weeks and 3 months.
In the first six months 81.0% of the MBTs were regressed or remain stable in size. After 3
months post GKS, 81.5% patients showed neurological improvement. 82.4% of the patients<65
years old survive for 12 months and 85% of patients with KPS>70 survive for 12 months.
The routine blood investigations, the gender and the location were of no significance on patients’
general outcome or the tumor/edema response to gamma knife. Presence of extracranial
metastasis, single or multiple MBTs found to have important effect on patients’ survival.

Results of Minimal Dosage Propranolol in the Management of Infantile Haemangioma

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 10-17

Infantile haemangioma one of the most common tumour of new borns , a safe and effective treatment
options are under ongoing research .
The authors show the effectiveness and safety of low dose propranolol as a method for infantile
haemangioma treatment .
In this study twenty- four patients with infantile haemangioma in different anatomical locations were
treated with oral propranolol and the result were assessed in a retrospective analysis of the results
patients were kept on 0.25 mg/kg/day for one month , then on 0.5mg/kg/day in 2 divided doses for
another one month , in the third month the dose will be increased to 1 mg/kg/day in 2 divided doses ,
then the propranolol were given in a maintenance dose ranging between 1-1.5 mg/kg/day in 2 divided
doses according to the clinical response .The duration of treatment ranging from 6-18 months as a
small dose increasing over a long time .
We had achieved excellent result in most of our patients, with reduction of size and fade of color of
hemangioma within 1 month from the initiation of treatment, when we stop the treatment no relapses
were noticed during our follow up period after finishing the course.
Propranolol is one of the safest and most effective treatment options for the infantile haemangioma
even in low dose, with lower relapse rates and minimal consecutive side effects and drawbacks.

Beta-2-Microglobulin as a Marker in Patients with Thyroid Cancer

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 18-22

Thyroid cancer is consider the most common of the endocrine system malignancies, also it
represents less than 1% of all tumors in human. Beta-2-microglobulin protein (β2M) is a low
molecular weight polypeptide (11800 Dalton), it is found on the surface of cells which contains
nucleus except red blood cells. It is a small subunit and the light chain of major histocompatibility
complex class I ( MHC- 1) also known as human leukocyte antigen (HLA) in human.
Aim of study:
Detection of the possibility of using Beta-2-Microglobulin protein as a marker for thyroid cancer.
A total of 49 patients with thyroid cancer, their mean age 37.77±13.84 years ranged (18-76 years)
were included in this study and healthy age-matched control group were 32 healthy donors, their
mean age 38.12±12.29 years ranged (19- 69 years) collected from healthy volunteers. Serum
creatinine level was determined by automated clinical chemistry analyzer. In addition to Beta-2-
Microglobulin protein was determined by Enzyme-linked Immunosorbent Assay technique.
The results of serum creatinine level showed a normal level of serum creatinine for all subjects
(healthy control and patients) except 14 patients with thyroid cancer who had a level of serum
creatinine out of normal range were excluded. Also the results showed significant increase (p=
0.0000001) in mean value of serum β2M protein in patients with thyroid cancer (group B)
compared to healthy control (group A). Also the results showed no significant correlation between
β2M protein and age (r= 0.153 , p-value 0.379). Also no significant correlation between β2M
protein and BMI (r= -0.092, p-value 0.598). Moreover, receiver operating characteristics ROC
showed β2M level excellent predictor in the diagnosis of thyroid cancer (area under the curve
AUC= 0.970 p<0.001).
A level of serum β2M is elevated in thyroid cancer and can be used as a marker for thyroid cancer
and an assistant in the diagnosis of this disease.

Assessment of the Improvement of Global and Segmental Diastolic Dysfunction after Coronary Arteries Revascularization

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 18-29

With respect to cardiovascular performance at rest and exercise, diastolic function is of equal
importance to systolic function, which is the ability of the ventricle to fill at low left atrial pressure and
diastolic HF have hospitalization rates similar to those with systolic dysfunction
To assess the effect of successful coronary revascularization on segmental LV diastolic dysfunction and
the effect of this segmental improvement on global diastolic function.
patients with diastolic LV dysfunction and ischemic heart disease that are documented by coronary
angiography were selected randomly in a prospective interventional study at Ibn Al-Bitar Hospital For
Cardiac Surgery from June 2012 till April 2013 and followed up to one month post coronary
revascularization with Doppler echo-parameters and tissue myocardial velocities for any Improvement
in global or regional diastolic dysfunction.
Twenty nine ischemic left ventricular segments of total 43 segments with diastolic dysfunction showed
improvement in diastolic function one month after successful revascularization.
Segmental diastolic dysfunction can be improved with revascularization of the stenotic coronary artery
supplying that segment.

Management of Traumatic Hemothorax a Retrospective Study of 165 Cases in AL-Jamhoori Teaching Hospital in Mosul

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 30-36

Traumatic hemothorax is one of the most common thoracic injuries in the world. There are a lot of
debates about the best method of management because of the possible risk of death and
development of subsequent complications.
The objective of this study is to decide the best type of management of traumatic hemothorax
(thoracostomy tube drainage versus thoracotomy) for life saving and prevention of subsequent
complications such as trapped lung with fibrothorax, and empyema.
This is a retrospective study of 165 consecutive patients with traumatic hemothorax admitted to
Al-Jamhoori teaching hospital in Mosul from 1st January 2010 to 1st January 2012. The parameters
that were used in this study were sex, age group, mechanism of injury, hemodynamic state at time
of according to volume of blood in the drainage bottle into5 groups. The patients were also
classified into 4 groups depending on their hemodynamic state at time of presentation.
Thoracostomy tube drainage was done in the majority of cases as the mainstay of treatment, in
minority of cases it was followed by thoracotomy for those with massive hemothorax, severe
hypovolemic shock, associated thoracic injuries, or those with complications.
Traumatic hemothorax should be treated initially by thoracostomy tube drainage except in very
urgent cases, and the decision for thoracotomy should be based on the hemodynamic state, the
volume of drained blood and the presence of associated thoracic injuries. A good initial care and
proper drainage of collected intrathoracic blood reduces the development of late complications and
the subsequent need for thoracotomy.

Bacteriological Diagnosis of Febrile Neutropenia in Oncology Teaching Hospital

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 37-42

Fever may be the only indication of a severe infection, it occurs in about (10 -50%) of patients
with solid malignancy during chemotherapy-induced neutropenia.
To determine the common pathogens causing febrile neutropenia and their susceptibility to
antibiotics in patients with solid malignancies in oncology teaching hospital.
50 patients with solid malignancy were enrolled in this cross sectional study. Blood culture and
sensitivity test were investigated for them. Other sample cultures were investigated according to
system involvement.
Blood culture was positive in 18% of patients. Gram negative bacteria were predominant
(81.81%). Among which E.coli being the most common (33.33%). E.coli was the isolate in the
only 2 (4%) positive Urine culture.
The most frequently effective antibiotic for Gram negative infections was Amikacin followed by
Imipenem compared to Ciprofloxacin, Tetracycline and Aztreonam for Gram positive ones.
Gram negative bacteria were the most bacteria isolated in the studied patients.

Gamma Glutamyltransferase as a Biomarker for Acute Coronary Syndrome

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 43-51

GGT ( gamma- glutamyl transferase ) enzyme is found on the surface of various cells and plays a
role in the catabolism of glutathione which is known as one of the major anti oxidants,
Of this study : was to emphasize the changed GGT values as anew biochemical marker for acute
coronary syndrome
Type of study is a case – control study. The study population: We enrolled 50 patients with acute
coronary syndrome who had been admitted to ccu unit in Merjan Teaching hospital, measurement
of serum gamma- glutamyl transferase level using gamma- glutamyl transferase was measured by
enzymatic method using the Abbott Architect C16000 autoanalyser and compared to the serum
gamma- glutamyl transferase level of the 50 control group , the period of the study is 6 months.
Both groups will under go an exclusion criteria for all causes that may lead to a high gammaglutamyl
transferase level mainly hepatobiliary diseases , alcohol history, diabetes mellitus , and
drugs that affect the gamma- glutamyl transferase level .
Of the study: showed that gamma- glutamyl transferase level is elevated in all patients with
documented acute coronary syndrome after exclusion of other factors which cause elevation of
gamma- glutamyl transferase in comparism with the control .
This study depicts association of gamma- glutamyl transferase with acute coronary syndrome in
population from Babylon governorate & Larger community based studies are needed to establish
the role of gamma- glutamyl transferase in development of the commonly mentioned risk factors
of acute coronary syndrome. We recommend the use of GGT as a biomarker within the 4 days
events of acute coronary syndrome .

The Value of Free Thyroid Hormones and Aspartate Aminotransferase in Vaginal Washing Fluid for Detection of Preterm Pre-Labor Rupture of Membrane

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 52-58

Preterm pre-labor rupture of membrane occurs in about 2% of all pregnancies. The most frequent
consequences of preterm pre-labor rupture of membrane is preterm delivery, sepsis and pulmonary
hypoplasia. The correct diagnosis of preterm pre-labor rupture of membrane is crucial and successful
management will be based upon it.
To determine whether measurement of vaginal washing fluid aspartate aminotransferase(AST) ,
free triiodothyronine (free T3) and thyroxin(free T4) were useful tests for the diagnosis of preterm
pre-labor rupture of membrane.
STUDY DESIGN: A case - control study.
SETTING: :This study was conducted at department of Obstetrics and Gynecology of AL-Yarmouk
teaching Hospital and National center for Diabetes
It included hundred pregnant women with a gestational age ranging between 24 - 36+6 weeks. They
were divided into two groups, the study group which included fifty pregnant women presented with
preterm pre-labor rupture of membrane and the control group which includes fifty pregnant women
without any complaint, matched for gestational age. All women underwent sterile speculum vaginal
examination. Free triiodothyronine and free thyroxin levels were measured by using Enzyme immune
assay method, and aspartate aminotransferase level was measured by using colorimetric method, in
vaginal washing fluid.
Vaginal washing fluid free T3, free T4 and AST levels were significantly higher in the study group
(1.15), (0.071), (4.9) respectively compared with the control group (0.93), (0.048), (4.5) respectively.
Vaginal washing fluid free T4 having the largest area under the curve on receiver operating
characteristic curve (ROC) analysis (P<0.001). ROC curve analysis showed that free T3 validity
results in predicting preterm pre labor rupture of membrane among pregnant women were (cut-off
1.07pg/ml, sensitivity 88%, specificity 76% and accuracy 82%), free T4 validity results were (cutoff
0.055pg/ml, sensitivity 84%, specificity 80% and accuracy 82%) and AST validity results
were (cut-off 4.9IU/L, sensitivity 52%, specificity 80% and accuracy 66%).
Measurement of aspartate aminotransferase free triiodothyronine , and thyroxin in vaginal washing
fluid of suspected and diagnosed patient presented with preterm pre labor rupture of membrane
found to be a useful markers for the diagnosis of preterm pre labor rupture of membrane.

Experience in Pediatric Pre-Adolescent Laparoscopic Cholecystectomy in Erbil

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 59-61

Gallstones in children are rare but can become a potentially serious condition [1,2]. Symptomatic
cholelithiasis that is requiring surgery in children has been increased in tendency over the last 10
years. The incidence of cholelithiasis in children ranges from 0.13 to 1.9 % and when compared
with the adult population , the risk of cholelithiasis incidence is assessed to be as 10–15 % . The
experience of pediatric surgical centers is estimated to be very scarce (3,4) . Contemporary
Laparoscopic Cholecystectomy is considered as the gold standard procedure in the management of
gallbladder diseases in both adults and children . Children that are considered to be a candidates for
surgery should be operated in pediatric surgery clinics experienced in minimally invasive
techniques (3) .
Pediatric laparoscopic cholecystectomy has not been evaluated in Iraq , here is an evaluation of
the procedure for 29 cases is presented mainly to study its application in this group of patients.
This is a preliminary study of 29 cases of pediatric laparoscopic cholecystectomy performed in
Erbil city in the period from 2011 to 2017. Age range was 5 months -11 years, 21 males & 8
females . Three of them were obese & one overweight . Both , three millimeter & 5 mm ports were
used , 4 ports were inserted .
Out of 29 cases, 21 (72.42 %) were males & 8 (27.58 %) were females, ranging from 5 months –
11 yrs . Twenty – five of the cases were electively operated on . Oral feeding started after 6 hrs ,
patients were discharged after 8 hrs except two patients who stayed for 36 hrs , mean hospital stay
was 13 hrs and 42 min . The mean operative time was 31 min (range from 20 min to 60 min) . The
was laparoscopic cholecystectomy performed by single specialist pediatric surgeon. All cases were
done as day case surgery except for the emergency cases. The time of hospitalization ranged from
8 hrs to 3 days. There were no intra operative complications that require reoperation such as injury
to the common bile duct or other viscera, bile leakage or vascular injury.
Laparoscopic surgery is a safe procedure in children for excising the gall bladder . Age of the
patient is not a contraindication to operation , and LC may be performed even in young children
with symptomatic gall bladder disease with low morbidity . it should therefore be considered as the
procedure of choice in pediatric patients (10,11) .

Evaluation of the Outcomes of Rhomboidal Flap "Limberg Flap” Repair Procedure for Sacroccocygeal Pilonidal Sinus Disease in Baghdad Teaching Hospital

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 62-67

Saccrococygeal Pilonidal sinus is a common surgical condition and its management is still
debatable, as many surgical techniques were developed aiming to improve outcome, better patient
satisfaction, and most importantly to prevent recurrence. Rhomboidal flap procedure "limberg flap"
is very safe and effective method for pilonidal sinus treatment due to its low complication rate
specially recurrence hence in this study we address the role of limberg flap procedure in
management of pilonidal sinus and how its complications are.
To analyze the outcome of "Limberg" Rhomboidal flap, in managing sacrococcygeal Pilonidal
sinus as a novel, with a potentially less complication and recurrence rate surgical procedure.
This is a prospective study on 44 patients suffered from sacroccocygeal pilonidal sinus, 36 patients
with primary disease and 8 patients had recurrent or previously managed pilonidal sinus collected
randomly in the 5th floor surgical department in Baghdad teaching hospital from June 1st 2014 to
December 10th 2015. All underwent rhomboidal flap procedure .there was no exclusion criteria,
data collected included demographic distribution, primary or recurrent pilonidal sinus, wound
complications, and recurrence. The minimum follow up period was 1 year after surgery.
44 patients had undergone this procedure most of them were males (41 patients), and
(3 patients) were females, youngest patient was a 16-year old and oldest one was 41-year old. Mean
agewas26. 1years±5.6SD, 5 patients (11.4%) had a previous formal surgical repair of pilonidal
sinus, 3 patients (6,8%) had a previous drainage of pilonidal abscess. The mean duration of the
disease is 10.9 months±6.9 SD.Our finding revealed that 3(6.8%) patients developed seroma ,
2(4,5%)patients had wound infection that all responded to conservative treatment. Other suspected
complications including flap necrosis, wound dehiscence and hematoma were not reported with any
of our patients.
Rhomboid flap is very safe and effective method for treatment of pilonidal sinus disease due to its
low complication rates especially recurrence of pilonidal disease, it also offers a good patient
satisfaction, although this procedure takes a longer operating time than the classical methods but it
is easy to be learned and practiced with efficiency .

Internet Addiction Disorder and Its Determinants among a Sample of Medical Students in Baghdad; 2017

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 68-75

Internet has become an important part of our daily life, despite a lot of beneficial services available
on the internet, excessive use may lead to negative consequences. College students are the most
at risk group
This research aimed at estimating the prevalence of internet addiction disorder and trying to find out
its determinants among Medical College Students in Baghdad..
This cross sectional questionnaire survey was conducted on a sample of Al-Kindy Medical College
Students in Baghdad using a self-administered questionnaire, information collected from 263 students
from April through May 2017.
The study showed that the Prevalence rate of internet addiction disorder among Al-Kindy Medical
College Students was 49 %.A statistically significant relation had been found between internet
addiction score and hours spent online daily, using social network applications and online games, and
daily hours spent online (p<0.05).
Internet addiction is common among Al-Kindy Medical College Students. Spending more hours
online per day, using social network applications and games were among the determinants of internet
addiction disorder.