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Article
Hepatocellular Carcinoma Presentation & Management , A Prospective Study in the Medical City Baghdad - Iraq

Author: Wissam Jaffar Altaee
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 2 Pages: 253-260
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACK GROUND :The development of HCC is a major global health problem , It's incidence has increased world wide and nowadays it constitute the 5th most frequent cancer representing around 5% of all cancers, and estimated to rank 4th in terms of mortality of cancers incidence world wide , it accounts for 80 –90% of all primary liver tumors . The Etiology of this tumor is multifactorial , certain viral, environmental & hereditary causes of cirrhosis have a strong correlation with HCC . HCC is a highly malignant tumor with poor prognosis .OBJECTIVE:To evaluated the Etiological , Epidemiological , Patho physiological , Diagnostic series , Therapeutic approaches & Advanced studies in detection and prevention of HCC .PATIENTS AND METHODS :Across sectional study of (57) patients with HCC ( 43 males , 14 females ) during the period from January 2000 to December 2002 . The patients were collected from medical & surgical units of Baghdad teaching hospital & the gastroenterology & hepatology teaching hospital .History taken from these patients & physical examination , Lab investigation ,CBP, liver function test ,Virology study , serum AFP. Titer ,U/S study , MRI , CT scan . Ascitic fluid tapping , Liver biopsy.Modalities of treatment : Palliative Treatment, Chemotherapy, Injection of Alcohol , Hemilobectomy ,Segmental resection , Debulking resection of tumor in the liver, Conservative treatment , any complications or hazards during surgical procedures were recorded.RESULTS :Male to female ratio is approximately (3:1), The mean age of (57.1) yr . more common between (51-60) yrs old ( 28.25% ) , Most of the patients were from Baghdad ( 47.4% ) . Increasing no. of patients from 2000 ( 21.1 % ) to 2002 ( 45.6 % ). (84% ) have previous history of chronic liver disease & (16%) haven't such a history . Most of chronic liver diseases are due to previous history of hepatitis B- infection (41.6%) . High level of AFP ( 66.6% ), all of them are of standard type of HCC. Ascitic fluid cytological study bloody (14%) & positive malignant cells (17.2%) . Liver biopsy (82.7%) had chronic liver diseases, and (96.5%) moderate to poorly differentiated type of standard HCC,(3.5%) fibrolamellar type .Outcome of treatment , Conservative (35%), Injection therapy (3.5%) , Chemotherapy (28%), Surgical procedures (16%) , Segmental & Right lobectomy (3.5%) for each , Debulking (9%) .CONCLUSION :AFP and U/S study are very important in the early detection and follow up of the patient with HCC , Liver biopsy - very important study to detect various type of HCC , Surgical resection is the only potentially curative treatment of HCC


Article
Intestinal Perforation of Pedunculated Hepatocellular Carcinoma CASEREPORT (Rare among rarities)

Author: Raafat Roof Ahmed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2008 Volume: 7 Issue: 2 Pages: 187-191
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:vascular stalk and is easily resected without sacrifice of significant amount of non-neoplastic liver tissue (1).BACKGROUND:Pedunculated type is a rare macroscopical form of hepatocellular carcinoma. THE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL.7, NO. 2, 2008CASE REPORT:47 years old male complained from vague abdominal pain, anorexia, weight loss and malena during the last few months. Abdominal ultrasound and spiral CT scan revealed a vascular mass 17x13 cm. in diameter occupying the whole right side of the abdomen. On exploration the mass was perforated into a segment of ileum due to direct invasion and attached to the liver by vascular pedicle. The mass was completely excised with segment of ileum followed by end-end anastomosis. Immunohistochemical study shows that the tumor was stained by alpha-fetoprotein staining confirming the diagnosis of pedunculated hepatocellular carcinoma.This is a case report of pedunculated HCC which perforated into small bowel causing severe bleeding per rectum, to highlight the importance of this rare and potentially curative disease.CASE REPORT :CONCLUSION:pedunculated hepatocellular carcinoma should be kept in mind in any differential diagnosis of large intraperitoneal mass even if it is not related to the liver by imagining study.


Article
POSSIBLE ROLE OF LYMPHOTOXIN Α, Β AND THEIR RECEPTOR (TLRS) IN PROMOTING LIVER CARCINOGENESIS DURING INFECTION WITH HEPATITIS C VIRUS

Authors: Areej A Hussein اريج عطية حسين --- Ghazi R Auda غازي رجب عودة
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2013 Volume: 11 Issue: 2 Pages: 124-134
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Lymphotoxin α, β and their receptor play an important role in the control of lymphoid organ development and support of immune responses against pathogens.Objective:To investigate expression of the lymphotoxin α, β and their receptor TLβRs using immunohistochemistry technique in patients with chronic active hepatitis and hepatocellular carcinoma.Methods:Thirty five formalin fixed, paraffin embedded liver tissues, obtained from Liver and Digestive System Technical Hospital and private laboratories in Baghdad, were studied. In addition, thirteen apparently normal liver autopsies were collected from the Forensic Medicine Institute Archives after permission and used as control group. Liver tissue sections were cut at 4 µm and placed on positively-charged slides, used for the detection of lymphotoxin α, β and receptor TLβRs by immunohistochemistry technique.Results:The expressions of lymphotoxin α, β and receptor TLβRs were detected in most patients infected with HCV, 88%, 84%, 76% respectively in patient with chronic active hepatitis and 80%, 70%, 90% respectively in patients with hepatocellular carcinoma while low level of expression of these markers was observed in healthy control group.Conclusion:Lymphotoxin α, β and their receptor TLβRs may play an important role in the development and progression of HCV associated liver pathology.Key words:lymphotoxin, TLR, carcinogenesis hepatocellular carcinoma.


Article
Outcome of Major Liver Resection in Gastroenterology & Hepatology Teaching Hospital Review of Nine Cases

Author: Talib AL-Jasha′ami
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 1 Pages: 113-117
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Major hepatectomies consider one of the most challenging procedure and did not becomecommonplace until the dramatic improvement in periopertive care in the 1980s.OBJECTIVE:Review the outcome of liver resection performed recently in Gastroenterology& HepatologyTeaching Hospital .PATIENTS AND METHOD:From June 2008 to March 2011, nine major anatomic hepatic resection was performed. Enucleation,Non- anatomic or wedge resection was excluded from this study.RESULTS:There were 4 men, 4 women and one child. Age range between 5-43 years median age 40 years.Nine major resection was done this include; extended right hepatectomy 1 patient, right hepatectomy2 patients, left hepatectomy 3patients, left lateral lobectomy 2 patients, right anterior sectionectomyone patient. The inflow pedicle was controlled either by extrahepatic approach in 6 patients orintrahepatic pedicle ligation by vascular stapler in 3 patients. Post-operative hospitalization was 3-16days, median 8 days. There were no mortality. Two patients developed bile leak in form of bilomawhich was treated by percutaneous drainage under ultrasound for 2weeks. Two patients developintra-operative hypothermia that led to stop the operation for one hour until warming of the patient.CONCLUSION:Major liver resection can be performed in our hospital with acceptable morbidity rate.


Article
Hepatectomy Experience in Baghdad Teaching Hospital

Authors: Safa M. Al-Obaidi --- Saieb S. Al-Gailani, Omar R. Mahjoub
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 2 Pages: 196-199
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: Hepatectomy is usually performed because it is the most effective way of removing liver tumour(s). Cryosurgery, Radiofrequency, Laser, Microwave and Chemo-therapies are less effective alternatives. OBJECTIVE: To review the experience of hepatectomy in Baghdad Teaching Hospital – Medical city,Iraq with a review of the obstacles and needs for promotion and development. PATIENTS AND METHODS: During the period from March 1999 to September 2005, Out of 27 patients admitted to the second surgical unit in Baghdad Teaching Hospital – Medical City with liver tumours, 15 had hepatectomy done by the same surgical team. The remaining 12 cases were beyond resection. RESULTS: The age of patients ranged from 2 to 65 years old with mean age of 34.4 years. Only one (6.7%) patient underwent left lobectomy, 2 (13.3%) left segmentectomy, while the rest 12 patients (80%) underwent right partial or total lobectomy, divided equally between anatomical & non-anatomical resection. Two main techniques were used in transection of liver parenchyma: CUSA Dissector which is used in 9 patients (60%) and clamp-crushing or finger fracture technique was used in the remainder. In addition to CUSA knife, argon beam was used in 5 cases (33.3%). Postoperative mortality rate was 26.7% (4patients). The histopathological examination of resected segments of the liver revealed 11 (73.3%) cases of hepatocellular carcinoma, 2 (13.3%) of hepatoblastoma, 1 (6.7%) case metastatic colorectal carcinoma, and 1 (6.7%) case of benign cells (haemangioma). CONCLUSION: Hepatectomy for liver tumours can be performed with acceptable safety and efficacy in a suitably staffed and equipped center. The outcome will improve with time and experience


Article
Evaluation Relationship between IL-10, IL-1α in Hepatocellular Carcinoma Patients
تقيم العلاقة بين IL-10, IL-1α لدى مرضى سرطان الكبد

Authors: Hameed Mahmood Majeed حميد محمود مجيد --- Malik Hadi Qadurie مالك هادي قدوري
Journal: Diyala Journal For Pure Science مجلة ديالى للعلوم الصرفة ISSN: 83732222 25189255 Year: 2017 Volume: 13 Issue: 3 - part 3 Pages: 104-113
Publisher: Diyala University جامعة ديالى

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Abstract

The presence of a high concentration of Interliukin-10 (IL-10) In the serum of patients with tumors It is harmful to the health of the injured useful for tumor And that because of its inhibitory properties of the immune response, and perhaps IL-10 works as a growth or a catalyst in stimulating the growth of cancer cells, the study aims to investigate IL-1α levels, IL-10, and evaluating the relationship between them in patients with liver cancer, samples were collected from the educational tumors National Hospital and Al-amal for the treatment of tumors / Baghdad, for the period from 25/07/2015 until 25/2/2016, taking as 5 cm 3 of venous blood of patients with primary liver cancer was 30 and secondary liver cancer was 20 were appointed before the treatment was up a set of secondary liver cancer after taking four doses of chemotherapy, and were compared to a group control of 20, the method is used by linked immunosorrbent assay (ELISA) to measure the level of cytokine, results showed the highest IL-1α levels, IL-10, at the level of probability p <0.01 between groups study, compared with the control group and there are no significant differences between groups The study, the study showed no significant differences among groups of secondary liver cancer before and after treatment.

ان وجود التركيز العالي من IL-10) ) Interliukin-10 في مصل مرضى الاورام هو مضر من الناحية الصحية للمصاب ومفيد للورم وذلك لما يتمتع به من خواص مثبطة للرد المناعي, وربما يعمل IL-10 كعامل نمو أو عامل مساعد في تحفيز نمو الخلايا السرطانية, تهدف الدراسة الى التحري عن مستويات IL-1α, IL-10, وتقيم العلاقة بينهما لدى مرضى سرطان الكبد, تم جمع العينات من مستشفى الاورام التعليمي والامل الوطني لعلاج الاورام / بغداد, للفترة من 2015/7/25 ولغاية 2016/2/25, اذ اخذ 5سم3 من الدم الوريدي من مرضى سرطان الكبد الاولي وكانت 30 عينه والثانوي وكانت 20 عينه قبل العلاج وتم متابعة مجموعة سرطان الكبد الثانوي بعد اخذ اربع جرعات من العلاج الكيميائي, وتم مقارنتها بمجموعة السيطرة البالغ عددها 20 عينه, واستخدمت تقنية الانزيم المرتبط الممتز المناعية لقياس مستوى الحركيات الخلوية, اظهرت النتائج ارتفاع مستويات IL-1α,IL-10 , عند مستوى احتمالية p<0.01 بين مجاميع الدراسة مقارنةً مع مجموعة السيطرة ولا توجد فروق معنوية بين مجاميع الدراسة, وأظهرت الدراسة عدم وجود فروق معنوية لدى مجموعة سرطان الكبد الثانوي قبل وبعد العلاج .


Article
Fine Needle Aspiration Cytology of Hepatocellular Carcinoma
علم الخلايا غرامة إبرة الطموح من سرطان الكبد

Author: Enas Abdulmajeed Rasheed إيناس عبد المجيد رشيد
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2011 Volume: 2 Issue: 172 Pages: 161-168
Publisher: Tikrit University جامعة تكريت

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Abstract

A prospective study of (13) patients, from both sex, with hepatocellular carcinoma was done in Salahuldeen government in Tikrit teaching hospital in period extent from Feb. 2006 to Aug. 2010. Patients divided into: 1-Those underwent FNAC for liver mass (5 patients) (38.5%), for diagnosis in addition to clinical and radiological evaluation with measurement of alfa-fetoprtein (AFP) level in the serum of them. 2-Those didn't undergo FNA and diagnosis made by clinical and radiological evaluation, and measurement of serum AFP level, in addition to excisional biopsy for liver mass. Follow up of patients for both groups made by 6-12and18 months by clinical and radiological evaluation for tumor seeding along needle tract, distant spread and median survival. It has been showed that tumor seeding along needle tract didn't encountered in this study. Distant spread included brain, bone, lung and abdominal wall no statistically differ in both group, and seen in three patients of those underwent FNA (60%),and five patients of those didn’t undergo FNAC (62.5%) (P=0.7). Median overall survival rate was 13 months(8-18 months) in FNA group and 12 months in non-FNA group (8-16). The cumulative 6, 12- and 18 months overall survival were 80%, 60% and 40% respectively for FNAC group and 75%, 50 and 37.5% respectively for non FNAC group. There was no statistically differences between two groups (P= 0.77).

وأجريت دراسة استطلاعية ل(13) مريضا، من كلا الجنسين، مع سرطان الكبد في الحكومة Salahuldeen في المستشفى التعليمي في تكريت مدى الفترة من فبراير 2006 إلى أغسطس 2010. المرضى تنقسم الى: 1-أولئك خضع FNAC لكتلة الكبد (5 مرضى) (38.5٪)، لتشخيص المرض، بالإضافة إلى السريرية والإشعاعية تقييم مع قياس ألفا، fetoprtein (اف ب) مستوى في مصل الدم منها. 2-أولئك لم يخضع FNA والتشخيص السريري الذي أدلى به والتقييم الإشعاعي، وقياس مستوى المصل لوكالة فرانس برس، بالإضافة إلى خزعة استئصالية للكتلة الكبد. متابعة المرضى لكلا الفريقين التي أدلى بها 6 أشهر من قبل 12and18 السريرية والإشعاعية تقييم للبذار ورم على طول المسالك الإبرة، وانتشار بعيدة ومتوسط ​​البقاء على قيد الحياة. ولقد اظهرت ان لم يكن مصادفة بذر ورم على طول إبرة الجهاز في هذه الدراسة. وشملت انتشار بعيد الدماغ والعظام والرئة وجدار البطن لا تختلف إحصائيا في كل مجموعة، وينظر في ثلاثة مرضى الذين خضعوا FNA (60٪)، وخمسة من المرضى الذين لم يخضعوا FNAC (62.5٪) (P = 0.7 ). وكان متوسط ​​معدل البقاء على قيد الحياة عموما 13 شهرا (8-18 شهرا) في مجموعة FNA و 12 شهرا في غير FNA للمجموعة (8-16). وكانت أشهر و 18 شهرا البقاء الإجمالي 80٪، 60٪ و 40٪ على التوالي للفريق FNAC و 75٪ و 50 و 37.5٪ على التوالي للفريق غير FNAC - التراكمي 6 و 12. لم يكن هناك أي اختلافات إحصائية بين المجموعتين (P = 0.77).


Article
Role of MicroRNA-221 and HCV Genotype in Predicting Chronic Liver Disease among Iraqi Patients
دورالحمض الريبوزي النووي الدقيق - 221 والنمط الجيني لفيروس HCV في التنبؤ بأمراض الكبد المزمنة بين المرضى العراقيين.

Authors: Dawood Salman Dawood داود سلمان داود --- Leena Falh Abd Al Reda لينا فالح عبد الرضا --- Akram Ajeel Najeeb اكرم عجيل نجيب
Journal: Al-Nisour Journal for Medical Sciences مجلة النسور للعلوم الطبية ISSN: 26640562 26640554 Year: 2019 Volume: 1 Issue: 2 Pages: 366-380
Publisher: Al-Nisour University College كلية النسور الجامعة

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Abstract

MicroRNAs (miRNAs) have been repeatedly shown to play important roles in liver pathologies, including hepatitis, liver cirrhosis, and liver cancer. miRNAs are small RNA molecules that have the ability to regulate gene expression by targeting mRNA degradation or translational repression. miRNA-221 is one of the over 700 kinds of currently known miRNAs and is up-regulated in multiple tumors. This work was carried out to evaluate the ratio of HCV genotype in the studied sample of Iraqi HCV positive patients and to assess the expression level of miRNA-221 in the plasma as a diagnostic marker of liver injury in chronic hepatitis C and (liver cirrhosis & hepatocellular carcinoma). Current study included 25 healthy controls, 35 patients with chronic hepatitis C, 20 patients with (liver cirrhosis and hepatocellular carcinoma) who attended to the Gastroenterology and Hepatology Teaching Hospital in Baghdad during the period from June/2017 to February/2018 were included in this study. HCV Genotype, viral load and miRNA-221 in the plasma were measured using real‑time PCR. This study showed that statistically significant differences in the mean values of miRNA-221 in plasma between the studied groups (P value =0.04) and also observed highly significant fold change in miRNA-221 expression was found between (liver cirrhosis and hepatocellular carcinoma vs control) groups. In conclusion measurements of miRNA-221 may be useful in the evaluation of HCV patients. Moreover, the most prevalence genotype in this study was genotype 4 then 1a.

لقد أثبت الاحماض النووية الريبوزية النووي ميكروي مرارًا وتكرارًا أنها تلعب أدوارًا مهمة في أمراض الكبد ، بما في ذلك التهاب الكبد وتليف الكبد وسرطان الكبد,وهي عبارة عن جزيئات الحمض النووي الريبي الصغيرة التي لديها القدرة على تنظيم التعبير الجيني عن طريق استهداف تحطيم الرنا المرسل أو القمع التعددية . الحمض الريبوزي النووي الميكروي 221 هو واحد من أكثر من 700 نوع من الاحماض النوورية الميكروية المعروفة حاليًا ويتم تنظيمها في أورام متعددة. يهدف هذا العمل تقييم نسبة النمط الوراثي الالتهاب الكبد الفايروسي سي في العينة المدروسة من مرضى التهاب HCV العراقيين وتقييم مستوى التعبير عن الحمض النووي الريبوزي الميكروي 221 في البلازما كعلامة تشخيصية لإصابة الكبد في التهاب الكبد المزمن C و (تليف الكبد و سرطان الكبد). اشتملت الدراسة الحالية على 25 عنصر تحكم صحي ، و 35 مريضًا يعانون من التهاب الكبد المزمن ، و 20مريضًا يعانون من تليف الكبد و سرطان الكبد ، والذين حضروا إلى مستشفى أمراض الجهاز الهضمي والكبد في بغداد خلال الفترة من يونيو / 2017 إلى فبراير / 2018 ، تم تضمينهم في هذه الدراسة. تم قياس النمط الوراثي HCV ، الحمل الفيروسي و miRNA-221 في البلازما باستخدام تفاعل البلمرة التسلسلي الكمي في الوقت الحقيقي. أظهرت هذه الدراسة أن فروق ذات دلالة إحصائية في متوسط قيم miRNA-221 في البلازما بين المجموعات المدروسة (قيمة P = 0.04) ولاحظت أيضًا تغيرًا كبيرًا في في تعبير miRNA-221 بين مجموعات (LC & HCC vs control) . من ناحية أخرى ، لم يكن هناك أي تغيير ذو دلالة إحصائية في مستوى التعبير miR-221 بين مجموعة (CHC vs control) أو مجموعة (CHC vs LC & HCC). وفي الختام ، قد تكون قياس miRNA-221 مفيدة في تقييم مرضى التهاب الكبد الفايروسي سي . علاوة على ذلك ، كان النمط الوراثي الأكثر انتشارًا في هذه الدراسة هو التركيب الوراثي 4 ثم 1 أ.

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