Background and Objectives Esophageal strictures in children have serious effects on the child health; the advances in digestive endoscopy opened the door for many therapeutic options, mainly endoscopic dilatation. The aim of the current study was to assess the causes of esophageal strictures in children and the outcome of endoscopic dilatation in Kurdistan center for gastroenterology and hepatology.Methods Retrospective study of 47 children with esophageal strictures undergone endoscopic dilatation at Kurdistan center for gastroenterology and hepatology.Results The predominant cases were corrosive strictures 46.8%, followed by postoperative 25.6% and peptic 21.3% strictures. They were submitted to 257 dilatation sessions, patients with corrosive strictures required more dilatation sessions and were discharged later than the other causes for esophageal stricture. Forty patients 85.1% were discharged; three were referred to surgery, while four are still undergoing the dilatation sessions. Esophageal perforation complicated the course in 2 cases (0.8% per procedure).Conclusion Endoscopic dilatation of esophageal strictures in children is a relatively safe procedure with good results and low rate of complications.

خلفية واهداف البحث: تأثيرات تضيق المرىء على صحة الطفل خطيرة، وفتحت التطورات الحديثة في تنظير الجهاز الهضمي الباب لعدة خيارات للمعالجة منها لاتوسيع التنظيري. الهدف من الدراسة هو دراسة أسباب تضيق المرىء لدى الأطفال و نتائج التوسيع التنظيري في مركز كردستان لأمراض الجهاز الهضمي.طرق البحث: دراسة ارتجاعية ل47 طفلا لديهم تضيق المرىء، اجري لهم توسيع المرىء التنظيري في مركز كردستان لأمراض الجهاز الهضمي .النتائج: كانت الحلات السائدة هي تضيقات عقابيل تناول المخرشات (الأحماض والقلويات) 48,6 %، يليها تضيقات عقابيل العمليات الجراحية 25,6 %, ثم تضيقات نتيجة ارجاع المعدي للمرىء 21,3%. أجرى 257 جلسة توسيع لكافة المرضى, احتاج مرضى تضيق الرىء جراء المخرشات الى جلسات توسيع أكثر من بقية المرضى كما تاخروا في اكتساب الشفاء. أربعون مريضا اكتسبوا الشفاء التام، ثلاث مرضى احياوا للجراحة فيما يستمر اربعة مرضى في جلسات التوسيع. انثقاب المرىء كان الاختلاط في حالتين من المرضى.الاستنتاج: التوسيع التنظيري لتضيق المرىء لدى الأطفال طريقة امينة نسبيا وذات نتائج ايجابية جيدة مع نسبة ضئيلة من الاختلاطات.

Endoscopy --- esophagus --- Stricture --- Dilatation

ABSTRACT:BACKGROUND:Carcinoma of Bladder is a common urological tumor. Urethral strictures with different grades are frequently seen in patients with non muscle invasive bladder cancer .OBJECTIVE:To elicit the incidence of urethral strictures, their severity and correlation with different factors in patients managed for non muscle invasive bladder tumor.PATIENTS AND METHODS:In a prospective study from January 2008 to January 2010 ,we followed 98 patients with superficial bladder tumor ,they were all male their age ranged from 38-76 years, all patients diagnosed endoscopically and histologically staged as superficial bladder tumor (excluding invasive bladder tumor),we follow those patients with a history regarding any change in urinary stream then urethrocystoscopically during a period of 1-2 years, we classify urethral strictures that was urethroscopically diagnosed as mild, moderate and sever.For each urethral stricture case we state the site and severity of the stricture, the number of preceding cystoscopies, duration of TURBT procedure and number of preceding chemotherapy sessions , the type of chemotherapy used and method of treatment required in each case.RESULTS:During the period of the study , a total of 23 urethral strictures (23.5%) were identified. They were all in the bulbar urethra, they were mild in 10 patients (43.5%), Moderate in 6 patients (26.1%) and sever in 7 patients (30.4%) and 14 patients with urethral stricture had also B.P.H(60.9%).Prior to the occurrence of stricture; urethrocystocopy was done once in 55.5% of cases , twice in 26.1% and 3 or more in 17.4%.Duration of TURBT procedure was≤20 mints in 30.4% and > 20 mints in 69.6%.Intravesical chemotherapy sessions were 0-3 in 17.4% of patients, 6 in 43.5% and more than 6 in 39.1%.The type of chemotherapeutic agent used was Doxorubicin in 56.5% of patients Mitomycin-c- in 26.1% and both of them (through multiple courses) in 13%.CONCLUSION:Urethral stricture associated with the management of non muscle invasive bladder tumors is a common and important clinical problem that need to be considered and avoided as far as possible ,Factors that may had a positive impact on the incidence of stricture were : B.P.H , duration of TURBT procedure, the number of intravesical chemotherapy sessions(6 and more) and doxorubicin instillation.

urethral stricture --- bladder tumour --- cystoscopy --- intravesical chemothcrapy

ABSTRACT:BACKGROUND:There is still controversy regarding the treatment of post-traumatic posterior urethral distraction injuries. Initial suprapubic cystostomy and delayed perineal urethral reconstruction has been considered the reference standard.OBJECTIVE:We review our experience with delayed perineal urethral reconstruction,with a focus on the long-term outcome and complications. PATIENTS AND METHODS:Between March 2007 and April 2012, 56 patients with posterior urethral distraction injury due to pelvic trauma underwent reconstruction with delayed perineal approach. Motor car accident were the main mode of trauma ocuring in 34 patients(60.71%)followed by blunt pelvic trauma in 15 patients(26.78%)and fall from height in 5 patients(8.92%).Bullet injury in 2 patients(3.57%).The definitive repair was delayed after a time interval ranging from 2 to 9 months (mean 2.83±1.14) after initial management . Mean patient age was 30.16±15.31 (range 6 to 65) years. In all cases, the area of fibrosis was aggressively excised, the corpus spongiosum was mobilized, and a tension-free, spatulated end-to-end anastomosis was achieved by splitting the corporeal bodies. The preoperative evaluation consisted of combined antegrade and retrograde cystourethrograms . A detailed sexual history was obtained in all patients . RESULTS:After a mean follow-up of 29.78±15.79 months (range 9 to 60 months ), 50 patients(89.28%) had a successful outcome (with or without additional urethrotomy).6 patients (10.71%)was considered a surgical failure ,endoscopy was unsuccessful .The patients is scheduled for another trial of surgical repair.CONCLUSION:Our results support the belief that delayed perineal reconstruction with extensive excision of fibrosis and a tension-free, spatulated end-to-end anastomosis is a successful treatment for posterior urethral distraction defects, with acceptable morbidity.KEY WORDS:urethral stricture,posterior urethral injuries,urethroplasty.

KEY WORDS:urethral stricture --- posterior urethral injuries --- urethroplasty.

In this paper we introduce a new concept −X θm open set and someconcepts are defined on it. Also, we introduce some conceptsofM −continuous multifunctions and we obtain somecharacterizations and some properties ofmultifunctions.

وبالاعتماد على هذا المفهوم قمنا بإعطاء θmX - في هذا البحث قمنا بتقديم مفهوم المجموعة المفتوحةمع بعض M − مفاهيم أخرى . كذالك قمنا بتقديم بعض المفاهيم الخاصة بالدوال المتعددة القيم المستمرةالمكافات لهذه الد

.words .and .phrases: −X m stricture --- . −X m .continuous .multifun ction --- −X θm open set

Background: Gastroesophageal reflux disease can lead to esophageal complications, including esophagitis, ulceration, stricture, hemorrhage, and Barrett's esophagus. However, the spectrum of problems associated with GERD has expanded to extra esophageal sites. Chronic cough and asthma are two clinical problems caused or triggered by GERD. Spirometric changes among GERD associated cough and asthma still a topic of ongoing research.Objectives: This study was designated to evaluate the spirometric picture of GERD associated cough and asthma subjects in relation to different clinical aspects of the disease including body mass index (BMI), disease duration, presence or absence of symptoms as well as endoscopic findings. Subjects and methods: Ninety adult subjects (90) of either sex with a mean age of 40.5±12 year are involved in this study. Fifty five (55) GERD associated cough and asthma subjects served as test group while the remaining (35) served as control group. Each subject underwent spirometry and gastric endoscopy in Pulmonary Function and Endoscopy Units respectively at Ibn-Sina Teaching Hospital /Mosul.Results: Spirometric data of the control group were within the normal predicted range (80-120%) thus excluding the possibility of any asymptomatic obstructive airway disease. Whereas, the measured spirometric parameters (forced vital capacity (FVC), forced expiratory volume in 1 second ratio (FEV1%), peak expiratory flow (PEF), and forced mid expiratory flow(FMF) are significantly reduced in the test group with a clear restrictive pattern among the overweight subjects. In addition, neither the presence nor duration of symptoms affected the spirometric picture of the GERD associated cough and asthma subjects, unlike those with positive endoscopy findings who revealed significant obstructive pattern when compared to those with negative endoscopy findings. Conclusions: GERD associated cough and asthma subjects with positive endoscopy findings showed obstructive pattern of spirometry irrelevant to the presence or absence of symptoms or duration of the disease.Key words: Gastroesophageal Reflux Disease, chronic cough, asthma.

الخلفية :إن الجزر المعدي المريئي قد يؤدي إلى مضاعفات في المرئ مثل الالتهاب , تقرحات ,تضيق ونزف المرئ وممكن أن تمتد ھﺬه المشاكل إلى أجزاء خارج المرئ وقد تكون سببا في السعال المزمن والربو القصبي .الأهداف :تقييم صورة وظائف الرئة في مرضى الجزر المعدي المريئي المرتبط بالسعال والربو القصبي وعلاقتها مع مؤشر كتلة الجسم , مدة المرض ووجود أو غياب الأعراض مع نتيجة فحص التنظير الداخلي .الاشخاص وطريقة العمل :تم اختيار تصميم دراسة المقطع العرضي الوصفي واجريت الدراسة في مستشفى ابن سينا التعليمي في الموصل . شملت الدراسة تسعون شخصا تتراوح اعمارهم بين (19- 65 سنة) من كلا الجنسين 35 شخصا كعينة ضابطة و55 مريضا يعانون من الجزر المعدي المريئي والسعال والربو وبعد أخذ جميع المعلومات اجري فحص وظائف الرئة لجميع المشمولين بالدراسة ثم اجري للمرضى ناظور المعدة .النتائج:أظهرت نتائج وظائف الرئة للعينة الضابطة أنها ضمن المدى الطبيعي (80-120%)مما يؤكد عدم وجود أي مرض في الرئة بينما كانت نتائج وظائف الرئة (FVC و ( FMF, PEF,FEV1% للمرضى منخفضة معنويا مع وجود تحدد واضح في وظائف الرئة لدى المرضى ذوو كتلة الجسم العالية .و وجود نمط انسدادي في وظائف الرئة لدى المرضى اللذين كان فحص الناظور موجب بالمقارنة مع المرضى اللذين كان فحص ناظور المعدة لهم سالب. الاستنتاج: إن وظائف الرئة لمرضى الجزر المعدي المريئي ذوو نتيجة ناظور معدة موجبة أظهرت نمط انسدادي بغض النظر عن وجود أو غياب اعراض المرض أو مع مدة المرض .انخفاض قيم وظائف الرئة للمرضى اللذين كانوا يعانون من الجزر المعدى لفترة اطول من ثلاثة اشهر عند مقارنتهم مع المرضى اللذين كانت فترة مرضهم اقل. مفتاح الدلالة:الجزر(الاسترجاع) المعدي المريئي ,السعال المزمن ,الربو.

Background: Gastroesophageal reflux disease can lead to esophageal complications --- including esophagitis --- ulceration --- stricture --- hemorrhage --- and Barrett's esophagus. However --- the spectrum of problems associated with GERD has expanded to extra esophageal sites. Chronic cough and asthma are two clinical problems caused or triggered by GERD. Spirometric changes among GERD associated cough and asthma still a topic of ongoing research. Objectives: This study was designated to evaluate the spirometric picture of GERD associated cough and asthma subjects in relation to different clinical aspects of the disease including body mass index --- BMI --- disease duration --- presence or absence of symptoms as well as endoscopic findings. Subjects and methods: Ninety adult subjects --- 90 of either sex with a mean age of 40.5±12 year are involved in this study. Fifty five --- 55 GERD associated cough and asthma subjects served as test group while the remaining --- 35 served as control group. Each subject underwent spirometry and gastric endoscopy in Pulmonary Function and Endoscopy Units respectively at Ibn-Sina Teaching Hospital /Mosul. Results: Spirometric data of the control group were within the normal predicted range --- 80-120% thus excluding the possibility of any asymptomatic obstructive airway disease. Whereas --- the measured spirometric parameters --- forced vital capacity --- FVC --- forced expiratory volume in 1 second ratio --- FEV1% --- peak expiratory flow --- PEF --- and forced mid expiratory flow --- FMF are significantly reduced in the test group with a clear restrictive pattern among the overweight subjects. In addition --- neither the presence nor duration of symptoms affected the spirometric picture of the GERD associated cough and asthma subjects --- unlike those with positive endoscopy findings who revealed significant obstructive pattern when compared to those with negative endoscopy findings. Conclusions: GERD associated cough and asthma subjects with positive endoscopy findings showed obstructive pattern of spirometry irrelevant to the presence or absence of symptoms or duration of the disease. Key words: Gastroesophageal Reflux Disease --- chronic cough --- asthma. --- الجزرالاسترجاع --- المعدي المريئي --- السعال المزمن --- الربو.