Table of content

Iraqi Academic Scientific Journal

المجلة العراقية للاختصاصات الطبية

ISSN: 16088360
Publisher: The Iraqi Borad for Medical Specialization
Faculty:
Language: English

This journal is Open Access

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E-mail:IPMJ2000@yahoo.com

Table of content: 2006 volume:5 issue:4

Article
Total Colectomy and Ileo-Rectal anastamosis Versus Total Procto-Colectomy and Ileo-anal (j) Pouch Anastamosis for Ulcerative Colitis

Authors: Zuhair R Al-Bahrani
Pages: 364-370
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ABSTRACT: BACKGROUND: The aim of this study is to compare the outcome of two sphincter-saving operations for ulcerative colitis namely total colectomy & ileorectal anastamosis (TC-IR) retrospectively with total procto-colectomy & ileo-anal (j) pouch anastamosis (TC-IA) prospectively. METHODS: Surgery was indicated in 89(7.84%) among 1135 patients with ulcerative colitis of these; 57 subjected to TC-IR (Group A) during period 1968-1990 and 32 to TPC-IA (Group B) between 1991-2005, by Z R Al-Bahrani at the Medical City Teaching Hospital and Al-Mustansiria Private Hospital, Baghdad. RESULTS: Of these 89 patients, 41 were males and 48 were females. Mean (range) age in years was 35.5+/-13.3 (12-65). Indications for surgery were; intractability 59(66.2%), carcinoma 13(14.6%), toxic colon 8(9%), sever bleeding 7(8%) and intestinal obstruction 2(2.2%) patients. The type of colitis were; pan-colitis 72(81%), left colitis 16(17.9%) and procto-sigmoiditis one (1.1%) patient. Pseudo-polyposis was seen in 52(58.5%) patients. The outcome of Group A (57 patients) were; post-operative mortality 2(3.5%), 1-3 complications minor and/or major in 31(53.4%) patients. After operation; normal defecation, bowel motion/day reduced from 8 to 5 (P<0.001), body weight/Kg increased from mean 53 to 62.5 (P<0.001) and the Hb gm/dl rose from mean 10.2 to 12.2 (P<0.001). The outcome of Group B (32 patients): post-operative mortality 1(3.1%), 1-3 complications minor and/or major in 16(50%) patients. After operation; control on defecation took few weeks-months to settle, bowel motion/day was reduced from a median 10 to 5 (P<0.001), body weight/kg increased from mean 52.9 to 56.2 (P=0.59[ns], and Hb gm/dl rose by a mean 03(P=0.68[ns]. CONCLUSION: Both surgical operations are super major and carry potential risk of complications and should be advised when medical treatment fails or serious complications of the disease arise which risk the patient’s life or interfere with his normal life. Both procedures improve bowel motion, general health and quality of life without incontinence but total procto-colectomy and ileo-anal with pouch is considered superior to total colectomy& ileor-rectal anastomosis because excluding to a great extent the risk of rectal cancer.


Article
The Role of Tamsulosin in the Management Of Lower Ureteric Stones.

Authors: Ayad Ali Al-Beer
Pages: 371-376
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ABSTRACT: BACKGROUND: Recent Studies have reported outstanding results concerning medical expulsive therapy (MET) for distal ureterolithiasis in terms of stone expulsion and control of colic pain. While ureteral intracorporeal and extracorporeal shock wave lithotripsy are recognized to be effective, the role of MET has not yet been established for the treatment of this disease. OBJECTIVES: To evaluate the role of α1- adrenergic antagonist Tamsulosin in conservative therapy for patients with juxtavesical ureteral stones. METHODS: Sixty consecutive symptomatic patients with juxtavesical unilateral lower ureterolithiasis from the urologic consultation department in Baghdad Medical City were enrolled in this randomized prospective controlled study during the period from January 2005 to December 2006. Patients were randomly divided into two groups, group 1 (n=30) and group 2 (n=30). The two patient groups used oral diclofenac (25 mg orally twice daily) plus cotrimoxazole 2 times daily for 5 days and 75 mg diclofenac injected intramuscularly on demand. All patients were instructed to drink 2 L water daily. Group 1, served as the control group. Group 2 was given the α1 -blocker (tamsulosin) in addition to conservative treatment. Tamsulosin capsule (0.4 mg) was administered daily. The treatment duration was until stone expulsion or 28 days, whichever came first. During this period, all patients were evaluated weekly by urinary tract ultrasonography and serum createnine level, and were asked whether they experienced acute colic pain, to score the intensity of pain according to a visual analog scale (VAS), whether the calculus passed spontaneously, the day and time of stone expulsion, number of diclofenac injections, and finally any drug side effects. Statistical analyses were performed with Student’s t test, ANOVA, and Mann-Whitney U test as appropriate. Correlation analysis was done using Spearman's rank test. Cox proportional hazard regression module was used to determine the predictive factors for expulsion. RESULTS: The stone expulsion rate was 70% for group 1 and 90% for group 2 (P=0.003). Mean stone size was 7.3 and 7.7 mm, respectively (P=0.24). Mean expulsion time, mean VAS of pain, mean attack of acute colic, and mean number of diclofenac injections were significantly less in patients used tamsulosin. Only therapy and stone size proved to be significantly predictive factors of stone expulsion (P<0.0001 and 0.001) respectively, while gender and age did not have any predictive value. Although side-effects, such as headache, abnormal ejaculation, and dizziness occurred more in patients who were given tamsulosin, no significant side-effects was detected so as to require exclusion of a patient from the study. CONCLUSIONS: Medical Expulsive Therapy (MET) for lower ureterolithiasis with tamsulosin during conservative treatment period is safe and effective as demonstrated by the absence of serious side effects and increased stone expulsion rate with early time. Also MET with tamsulosin affords an outstanding control of pain for patients while waiting for stone expulsion.


Article
Effect of Pentoxifylline on the Outcome of Artificial Inseminations

Authors: Saad S. Al-Dujaily
Pages: 377-383
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ABSTRACT: OBJECTIVE: To highlight the effect of Motility Stimulant Pentoxifylline (PF) used to activate semen samples when managing couples suffering from primary Infertility due to either unexplained reasons or mild male factors by Artificial Insemination. DESIGN: Prospective study. SETTING: Institution of Infertility Treatment and Embryo Research, Al-Nahrain University, Baghdad -Iraq. METHODS: Ninety four couples suffering from mild male or unexplained primary infertility were involved in this study. According to results of Postcoital test (PCT) performed to the participants prior to Insemination, they were divided into two groups. Group 1 (67 couples) women with positive (+ve) PCT (>5 motile sperm /HPF), they underwent alternative cycles of Intra- uterine and Intra-cervical Inseminations (IUI) (ICI). Group 2 (27 couples) those with negative (-ve) PCT (< 5 motile sperm/HPF), they were inseminated by intra-uterine method only. The couples underwent 120 insemination cycles. PF was added following sperm washing in 81 inseminations. Where as 39 inseminations were performed after sperm washing technique only. RESULTS: The study recorded 18% pregnancy rate (17 out of 94 women). IUI was done in 72 cycles in which PF was added following sperm washing in 48 cycles resulting in 10 pregnancies (20.8%). While only two women conceived form 24 IUI cycles without using PF (8.3%). This difference is statistically significant (P<0.05). On the other hand, ICI was done in 48 cycles; PF was used in 33 cycles successfully resulting in 5 pregnancies (15.15%). Whereas , no pregnancy recorded when PF not used in the remaining 15 ICI. PF was used in 8I insemination cycles treated by IUI or ICI had resulted in 15 pregnancies (18.5%). This result is significantly higher (P<0.05) than the recorded pregnancy rate of the control group in whom 39 inseminations with IUI and ICI done without using PF (2/39, 5.1%). CONCLUSION: Pentoxifylline improves pregnancy rate when used to activate sperm function in both Intrauterine and Intracervical Inseminations.


Article
Scalp Burns: Evaluation of electrical versus Thermal Scalp Injury

Authors: Ahmed A.K.Mohammed Nawres
Pages: 384-390
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ABSTRACT: BACKGROUND: Scalp burns present as functional and aesthetic problems. The line of management depends mainly on the depth of burn wound and the presence or absence of underlying bone involvement. OBJECTIVE: We demonstrate the differences between thermal and electrical scalp injuries regarding depth and management. METHODS: Records of all burned patients admitted to Hilla General Teaching Hospital between April 2004 and June 2006 were reviewed. Ten patients with electrical scalp injuries were identified and compared with twenty patients with thermal scalp burn. RESULTS: The incidence of calvarial bone involvement was 100 % in electrical scalp injured patients while all patients with thermal scalp burn were partial thickness (bone free) during the study period. The mean age was eighteen years for the electrically injured patients (ranged from 14 to 30 years) and four years for the thermally burned patients (ranged from 2 to 8 years).Treatment was achieved with early bone debridement and immediate local scalp flaps coverage for electrical scalp injured patients while most of thermal scalp burned patients were healed spontaneously. CONCLUSION: Debridement of the electrically injured scalp with flap coverage is advisable to be performed with in 3rd to 5th day after the injury rather than waiting for the settlement of the progressive necrosis, the known unique effect of electrical current.


Article
Evaluation of Bulbocavernosus Reflex in the Investigation of Diabetic Impotence

Authors: Usama Al-Nasiri
Pages: 391-395
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ABSTRACT: BACKGROUND: The pathology of erectile dysfunction may be an autonomic neuropathy, vasculogenic, endocrine deficiency, psychological or a combination of these factors. This study was undertaken to determine the predictive value of Electrophysiological elicited Bulbocavernosus Reflex in discrimination between neurogenic and non- neurogenic impotence in diabetic patient. METHODS: Twenty five male diabetic patients were recruited from out-patients attending the urology department at AL-KADIMYA Teaching Hospital. Bulbocavernosus Reflex (BCR) was evaluated on all patients at AL- NAHRAIN College of Medicine department of physiology, using the methods described by Rushworth. RESULTS: Test sensitivity was 72%, while test specificity was 83.3%. An abnormal Bulbocavernosus reflex carries a high probability of neuropathology. CONCLUSION: A degree of objectivity in the evaluation of possible neurogenic impotence can be offered by testing the Bulbocavernosus Reflex.


Article
An Echocardiographic Study of Valvular Heart Disease Associated with Systemic Lupus Erythematosus

Authors: Safa Ez-Aldeen Al-Mukhtar
Pages: 396-405
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ABSTRACT: BACKGROUND: Valvular heart disease is the most important cardiacmanifestation of systemic lupus erythematosus (SLE). We performed a study to determine the relation of valvular disease to other clinical features of lupus, the type and the incidence of valvular heart disease in SLE patients. METHODS: We performed transthoracic echocardiography (TTE) and rheumatologic evaluations in 56 patients with systemic lupus erythematosus. The echocardiographic findings were compared with those in 40 healthy volunteers. RESULT: Abnormal valvular Echocardiographic findings were multiple valvular abnormalities found in 21 patients (37.5%), were distributed in three groups according of valvular involvement: (Group1) included patients with anatomical and functional valvular involvement (AFVI) in seven patients (12.5%). (Group2) included patients with anatomical valvular involvement without Doppler detected valve dysfunction (AVI) in 11 patients (19.6%). (Group3) included patients with functional abnormalities (stenosis or regurgitation) without valvular thickening (FVI) in three patients (5.3%). Positive antiphospholipids antibody (aPLs) was found in a total of 29 patients (51.7%), of those 17 patients (58.6%) had valvular echocardiographic abnormalities and four patients (14.8%) of the 27 patients with negative aPLs had abnormal echocardiographic findings. CONCLUSIONS: Valvular heart disease is common in patients with SLE, valvular abnormalities were correlated with the aPLs in patients with SLE. Echocardiography is an excellent tool for the diagnosis and follows up of valvular abnormalities in patients with SLE.


Article
The Role of Circulating Immune Complexes in the Pathogenesis of the Ischemic Heart Disease

Authors: Suha AL-Fakhar
Pages: 406-410
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ABSTRACT: BACKGROUND: Circulating immune complexes (CICs) were found to have an effect on the pathogenesis and prognosis of ischemic heart disease (IHD). METHODS: A total of 24 patients, 13 as a patient group with IHD (10 males and 3 females), and 11 healthy control group (6males and 5 females), for all the level of CICs was detected by platelets aggregation test (1). RESULTS: The results showed that all patients with IHD had positive platelets test, while only 4control group had a positive results. CONCLUSION: This study showed that there was significant raise in the level of CICs in the IHD and it might play a role in it’s development.


Article
Comments on Surgical Management of Penetrating Duodenal Injuries

Authors: Raafat R. Ahmad*, Talib A. Majid
Pages: 411-417
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ABSTRACT: BACKGROUND: Duodenal injury is one of the most serious abdominal traumas that should be treated properly otherwise it may result in lethal complications. Aim: Is to apply simplified guidelines for the surgical management of duodenal injuries so that it might reduce the incidence of morbidity and mortality. CASE SERIES: During the last three years, nine patients with duodenal fistula as a result of penetrating duodenal injury were referred to Gastrointestinal and Hepatology Teaching Hospital, all these patients were reviewed to determine the severity of the duodenal injury according to the Organ Injury Scale and to discuss the surgical procedure which was performed. COMMENTS: The recommended operative management for grades I & II duodenal injury is simple primary repair, for grade III is pyloric exclusion or jejunal serosal patch, for grade IV is duodenal diverticulization, and for grade V is Whipple’s operation. In addition to that damage control surgery can be applied in certain circumstances. CONCLUSION: The simple primary repair is not sufficient treatment of moderate to severe duodenal laceration and the surgeons should adopt more advanced procedure.


Article
A Study of Diabetic Foot Ulcers in Relation to Depth , Location of the Ulcer and Patient's, Age and Sex.

Authors: Ryath S.AL-Hemedawi
Pages: 418-421
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ABSTRACT: BACKGROUND: Over a nine months period, extending from October, 2002 through July 2003, microorganisms were isolated and identified from foot ulcer infections of diabetic patients. The foot ulcers were clinically identified as superficial (dry, wet) or deep ,the depth of both superficial (wet, dry) and deep foot ulcers in relation to location, patient age and sex were studied from 60 patients of surgical wards. METHODS: The depth of different diabetic foot ulcers were measured by sterile cotton tip applicator inserted from the surface to the deepest point of the ulcer base. RESULTS: It was demonstrated that the superficial ulcers were mostly wet, the site of the ulcers were mainly in the right foot more than in left foot, mostly the toes. The incidence of deep ulcers were mostly in males, while the prevalence of both superficial and deep ulcers increase with advancing age. CONCLUSION: The present study showed a different classification of foot ulcers (superficial &deep) from past literature studies.


Article
Psychosocial Burden among Adolescents with Type 1 Diabetes: a preliminary report

Authors: Jawad K. A. Al-Diwan.
Pages: 422-425
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ABSTRACT: BACKGROUND: Adolescents with type 1 diabetes are faced with a complex set of challenges (developmental changes and demands of the disease). This study was carried out to assess the role of psychological, behavioral and social concern among Iraqi adolescents with type 1 diabetes. METHODS: Adolescents with type 1 diabetes were enrolled in the study from different diabetic centers in Baghdad from 1st June to 21st Dec. 2000. Each participant was interviewed individually. Full information including age, sex, duration, sport activity, frequent hospitalization, visits to diabetic clinic and educational level were included. Psychological burden was assessed by determination of social interaction, family interaction, mood, dissatisfaction with body image, emotions, stress and perception. Univariate analysis was used to examine which variables were associated significantly and dependently with psychosocial burden. RESULTS: A total of 160 adolescents with type 1 diabetes were included in the study. Their age was 15.1 ± 2.3 years, 53.8% of them were females. 76.9% of the adolescents reported a history of frequent hospitalization. Psychosocial burden was significantly associated with age and sport activity. CONCLUSION: The findings point to importance of psychosocial factors in management of diabetes. More research in this area is needed to develop psychosocial intervention program and to demonstrate the cost effectiveness of these approaches.


Article
A Study On The Common Microorganisms Causing Vaginitis

Authors: Aroub Abdul Rahman Al-Kaisi
Pages: 426-430
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ABSTRACT: BACKGROUND: Inflammation of the vaginal mucosa is a common clinical syndrome. Women often complain of an abnormal discharge and possibly other symptoms such as offensive odor or itching. Trichomonas vaginalis ,candida albicans with other species of candida are well recognized causes of vaginitis Another type of vaginitis referred to as bacterial vaginosis is believed to be caused by Gardnerella vaginalis However, a purulent discharge from the endocervix can be observed in some cases of cevicitis, the endocervix is the site from which Neisseria gonorrhoea is most frequently isolated in women with gonococcal infections. AIM OF THE STUDY: This study was concerned with the isolation of common microorganisms which may present in female abnormal vaginal discharge. METHODS: The study was conducted in the period from November 1992 to August 1993 on 480 female patients presented with vaginal discharge with or without pruritis vulvae attended the Gynecological and Antenatal Outpatient Clinics in Baghdad Medical City compared to 50 females complaining of gynecological problems other than infection attended the same clinic. Different laboratory methods were carried out during this work to isolate Trichomonas vaginalis , Candida species, Gardnerella vaginalis and Neisseria gonorrhoeae RESULTS: Among 480 female patients subjected to this study, 92 were positive for Trichomonas vaginalis (19.16%), Candida species were found in 118 patients (24.58%), Gardnerella vaginalis was reported in 94 (19.58%), while Neisseria gonorrhoea was seen in 8 patients (1.66%). Infection with both Trichomonas vaginalis and Gardnerella vaginalis was reported in 22 patients (23.91%), simultaneous infection of Trichomonas vaginalis and candida species was reported in 5 cases (5.43%), and in 7 patients combined infection of both Trichomonas vaginalis and Neisseria gonorrhoea was seen (7.6%). CONCLUSION: The highest rate of combined infection was seen in infected cases with both Trichomonas vaginalis and Gardnerella vaginalis, since both favor the growth in similar environment especially in (PH>4.5).


Article
A Three Years Review of Accidental Poisoning in Children at Fatema Al-Zahra Teaching Hospital, Baghdad.

Authors: Kholod Daher Habib
Pages: 431-434
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ABSTRACT: BACKGROUND: Accidental poisoning due to ingestion of potentially toxic substances is a major cause of morbidity in children worldwide .The purpose of this Study was to determine the prevalence and patterns of ingestion potentially toxic substances by children in Fatema AL-Zahra teaching hospital which served the eastern parts of Baghdad and to recommend plans for poisoning prevention. METHODS: Medical records of patients admitted to the pediatric medical department (p.m.d) in Fatema Al-Zahra teaching hospital because of accidental poisoning during the last 3 years (January 2004 to December 2006) were reviewed. RESULTS: A total of 13351 children were admitted to the pediatric medical department during the study period .Of these,110 children were reported as cases of accidental poisoning .The highest percentage of poisoning were found in the 1-2 years (yr) age group about 56 cases (50.9%) . Hydrocarbons ingestion accounted for the highest proportion of childhood accidental poisonings 53cases (48%). CONCLUSION: Although one case of death was reported in this study, continuous education of parents and caregivers of young children is recommended, as this would help to reduce the chances and complications of accidental poisoning.


Article
The Prevalence of Silicosis Among Iraqi Silica Quarrying Workers

Authors: Waleed Gh. Al-Tawil
Pages: 435-441
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ABSTRACT: BACKGROUND: Silicosis is reported as the most prevalent, chronic and irreversible lung disease which is caused by the inhalation of respirable silica dusts and associated with prolonged exposures among workers dealing with. It is one of the oldest fibro-nodular, occupational, incurable lung disease caused by inhalation of dust containing free crystalline silica. OBJECTIVES: This study aimed to assess the prevalence and risk factors for silicosis among workers exposed to freesilica. METHODS: In this cross –sectional study, we studied ninety male workers in the quarrying zone of silica in the IraqiWestern Desert. The workers were subjected to clinical interviews and examinations, spiro-metric andchest radiographic examinations. RESULTS: It was found that the prevalence of silicosis among these 90 workers was 25(27.8%), 18(20%) and16(17.7%) depending on suggestive clinical, spiro-metric and radiographic findings respectively. CONCLUSIONS: Silicosis is an important and common health hazard affecting quarrying workers in Iraq. The ill healtheffects of silicosis (diagnosed by suggestive clinical findings, radiograph &/or spirometry) are moreprevalent in workers with direct exposure or have more than 10 years exposure to silica dust. Smokingis not a risk factor for silicosis. The implementation of accurate and scientific medical supervision forthe workers, with the establishment of proper medical recording system are important steps inprevention the adverse health effects of silica.


Article
Patients with Childhood Leukemia are at High Risk for Transfusion-Transmitted HBV and HCV Infections

Authors: Ruqia M. Al-Barzinji
Pages: 442-446
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ABSTRACT: BACKGROUND: This work presents estimation to the number of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among polytransfused leukemic children, who received chemotherapy. METHODS: A total of 88 serum specimens were collected from children with leukemia aged between 1-12 years (60 males and 28 females), attending Al-Mansoor Teaching Hospital, seen during the period from January to October 2004 to determine if the patients with childhood leukemia are at high risk for transfusion- transmitted HBV and HCV infections. Enzyme linked immunosorbent assay (ELISA) test was used to determined infected and non infected individuals. RESULTS: Out of the 88 children studied, Hbs Ag was detected in 18 (20.45%) including 12 (66.6%) males and 6 (33.3%) females, whereas anti HCV was detected only in 4 (4.54%) children including 3 (75%) males and 1 (25%) female. The peak prevalence of HBV infection was recorded in children of age 9-12 years and reached (23.33%) while in HCV the peak prevalence was in age group (6-9), being (66.6). CONCLUSION: In this study, the prevalence of anti HCV and Hbs Ag were high in patients who were treated for children leukemia. The high incidence of hepatitis infections was recorded in polytransfused leukemic children.

Keywords

HBV --- HCV --- Leukemia --- Children


Article
Primary Intramuscular Hydatid Cyst of the Biceps Brachii Muscle Accurately Diagnosed Preoperatively.

Authors: Karim AL-Araji
Pages: 453-454
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CASE REPORT: A 43-year-old lady who presented with a soft tissue mass in the anterior aspect of the left upper arm which was enlarging over the last three years . The mass was painless and the patient was a febrile, without weight loss and denied any history of trauma. Physical examination revealed a non-tender, soft , fluctuant , nonpulsatile mass of about 4 , 3 , 3 cm in dimensions in the biceps brachii muscle and it was mobile with contraction of the muscle . No erythema, ecchymosis, warmth or lymphadenopathy was determined. Ultrasound of the local area revealed a unilocular, echo free mass. Fine needle aspiration from the cyst was performed, which yielded crystal clear fluid and microscopic examination of fluid was inconclusive. Based on these findings, a working diagnosis of hydatid cyst arising from muscle was made . Screening for other hydatids in the abdomen by doing ultrasound or in the chest by doing chest x-ray were both negative. After preoperative preparation the mass was explored which revealed the presence of whitish cystic mass inside the biceps brachii muscle typical of hydatid cyst (Figures 1, 2, 3) .

Keywords

“Hydatid --- Muscular --- Biceps “

Table of content: volume:5 issue:4