Vol 13, No 1 (2009)

Background and objective: Acute perforations of duodenal ulcers continue as one of the real emergencies of surgery which require immediate attention and prompt operation. The aim of this study was to evaluate the probable risk factors for perforation of duodenal ulcer, highlighting any prevalent one in the occurrence of perforation in Erbil governorate. Design: Retrospective study. The cases were selected on the basis of structured protocol. Setting: The study was performed on 124 patients with perforated duodenal ulcer attending the emergency departments of the three major hospitals in Erbil city (Erbil emergency hospital, Hawler teaching hospital and Hawler private hospital) Erbil governorate located in Iraqi Kurdistan over a period of 4 years.

Methods: The study was performed on 124 patients with perforated duodenal ulcer over a four year period (Jun. 2000- Jun. 2004). A number of probable risk factors for perforation of the duodenal ulcer were studied. Asymptomatic patients who perforated were studied as a separate group.

Results: one hundred twenty four patients with duodenal ulcer perforation were studied, 111 male and 13 female (male to female ratio 8.5:1) about 60% of patients were within their 4th and 5th decade of age. Patients residing in the rural areas had a lower incidence of perforation (39%) than that living in the urban areas (61%). seventy four patients (59.6%) were asymptomatic before they developed the perforation. Sixty six patients (53.2% of the total number) developed the perforation during Ramadan fasting months (four out of the total 48 months), sixty five percent of the cases were smokers. Stress and smoking played a significant rule in the occurrence of perforation in 83% of cases.

Conclusion: Stress, smoking and fasting played a major rule as a risk factor in the occurrence of duodenal ulcer perforation. A high incidence of perforation occurs during the months of Ramadan fasting, especially those without or on irregular treatment. The incidence of asymptomatic patients who were fasting and under stress, who then perforated was high.

Background and objective: Poly unsaturated fatty acids(PUFAs ) that contain two or more double bonds are particularly susceptible to oxidation by free radicals and other highly reactive species. Malondialdehyde( MDA) is one of many low molecular weight endproducts of lipid hydroperoxide decomposition and is the most often measured as an index of lipid peroxidation. The aim of the present study was to measure the serum level of MDA in healthy non athletics and athletics.

Methods : This study was carried out during the period from April 2007 to September 2007 on 53 healthy non athletics (27 males and 26 females), and 31 healthy athletics (16 males and 15 females). Serum MDA level was measured colorimetrically using thiobarbituric acid method .

Results: The mean value of serum MDA was significantly higher in healthy athletics than that of healthy non athletics (p<0.05). The mean value of serum MDA in females was non significantly higher than that of males (p>0.05) in both groups . The mean value of serum MDA was significantly higher in healthy non athletic smokers than that of non smokers (p<0.001) .

Conclusion: Based on the findings of the present study , it can be concluded that regular exercise training causes excess lipid peroxidation and generation of significant amounts of MDA, one of the most important harmful free radicals .Therefore athletics should take a diet rich in antioxidants or appropriate amount of antioxidant vitamins ( A, C,and E) .

Background and objective: Thoracic outlet syndrome (TOS) is a clinical phenomenon resulting from compression of neurovascular structures at the superior aperture of the thorax which presents with varying symptoms The aim of this study was to analyze the different kinds of clinical presentation of thoracic outlet syndrome in Kurdistan region of Iraq and its management.

Methods: In Erbil teaching hospital, 150 patients have been studied from February 2000-December 2006. These patients diagnosed as symptomatic thoracic outlet syndrome and have been managed conservatively and surgically.

Results: In this study 97 (64.6%) patients were female, 53 (35.3%) patients were male. Their ages ranged from (17-40) years. There was pain, parasthesia in arm in 69 (46%). Shoulder pain, chest pain and pain in axillarys region with arm pain in 38 (25.3%) patients (diagnosed by cardiologist as they have cardiac problem and treated accordingly without benefit). Incidental findings in 27 (18%) patients with vague symptoms in upper limb, supraclavicular fullness in 2 (1.3%) patients, 12 (8%) patients diagnosed by psychiatrist as having psychological problem (misdiagnosed as obsessive or depressive cases because of there neck pain and headache) and one patient has wasting of hand muscles. Surgery done for 25 (20.5%) patients (supra clavicular approach).

Conclusion: Careful patients history and proper physical and clinical evaluation including nerve conduction study, conventional radiography of cervical spine can decide proper management for symptomatic cases conservatively or surgically.

Background and objective: Moderate and Heavy/binge alcohol drinking among medical college students have become a major public health problem. There is consistent evidence suggesting that young adults in college are drinking more than their non–college-attending peers, but it is still not clear whether they are more likely to suffer from clinically significant alcohol use disorders. This article reports the first national assessment of patterns of drinking habit among Medical Colleges. The aim of this study was to monitor the use of alcohol and to search for intervention and prevention strategies in Medical college communities.

Methods: This is a cross-sectional study. Young adults students (n = 342) in four Medical College in Hawler Medical University were studied from the period between 20th Feb 2007- 20th April 2007 regarding use of alcohol, they were between 17-29 years old, 36% female, 64% male. A semi structured Questionnaires were distributed to students living in the four Medical colleges. The questionnaires asked for information on age, residency (how long they had lived in the college) and what substances they had used in the 6 months prior to the study (cigarettes, alcohol). The students also asked about academic and social activities. The data were expressed as descriptive frequencies and percentages.

Results: 19.3% of college students (18, 4% of men, 0.9% of women) has occasional alcohol drink in the in the past 6 month, 4.4% has moderate to binge drinking which was completely among male students, students from College of Medicine form the higher rate of alcohol users (12.8%), while College of Nursing form the lowest rate (0.6%). Bars and restaurant form the major drinking context for the students (44.5%).

Conclusion: The problem of alcohol use is increasing among students from medical college / Hawler University. College-based interventions seem desirable, especially in boys.

Background and objective: Patients undergoing laparoscopic cholecystectomy (LC) experiences post operative abdominal pain. This study aimed to determine the character of pain after LC and its relief with 0.5% bupivacaine-soaked gelfoam placed in the gallbladder bed.

Methods: A prospective randomized, double blinded placebo-controlled study was conducted on 200 patients with chronic cholecystitis, patients were divided into four groups of 50 patients :group A (2 mg/kg 0.5% bupivacaine-soaked gelfoam kept in gallbladder bed), group B (2 mg/kg 0.5% bupivacaine infiltrated at trocar sites), group C ( 1/2 of the required dose of 2 mg/kg 0.5% bupivacaine infiltrated into the gallbladder bed and at trocar sites, and group D (normal saline in the gallbladder bed and at trocar sites). Postoperatively, the character of pain was noted, and its relief was assessed with verbal rating scale (VRS) scoring.

Results: 77.50% of the patients had visceral, 60.50% had parietal, and 23.50% had shoulder pain postoperatively. The visceral pain was significantly less in group A patients than in the control patients (p < 0.01),the mean VRS score at 4, 8, 12 and 24 h in the group A patients also was less than in control group D. Trocar-site infiltration alone was not effective in relieving the parietal pain.

Conclusion: Visceral pain is prominent after laparoscopic cholecystectomy and can be effectively controlled by 0.5% bupivacaine-soaked gelfoam in the gallbladder bed alone.

Background and objective: The justification of the routine use of the episiotomy arouse at the beginning of 20th century. It was based on personal beliefs without scientific basis and this led to the incorporation of episiotomy in daily practice . High-quality methodological studies gave strong evidence that episiotomy should not be done routinely. The purpose of this study was to find out the rate and degrees of perineal tear in women with versus without episiotomy and to evaluate the severity of pain and complications including wound infection, wound dehiscence and dyspareunia.

Methods: This is a prospective interventional study included 200 primigravida with term pregnancy, who attended the labor room at Maternity Teaching Hospital from 1st of January 2008 till 1st of July 2008. Episiotomy was done for a group and avoided in another group, then follow up was done to evaluate complications.

Results: Perineal tears were significantly more in patients with episiotomy as episiotomy itself is regarded as second degree perineal tear. There was significant difference in the severity of pain, wound infection and dyspareunia among both groups but there was no significant difference in the Apgar score of the newborn in both group.

Conclusion: This study does not supports maternal benefits of routine episiotomy.

Background and objective: Honeymoon sexual dysfunctions mean the inability of men to do first sexual intercourse with their virgin wives. Immediate causes include performance anxiety or fear of failure, lack of adequate stimulation, and relationship conflict. To study the sociodemographic and etiological factors concerning men sexual failure in wedding night.

Methods: The study was undertaken between the period of December 2004 and December 2007 at Azadi general hospital, which included 60 male patients presented to the psychiatric out-patient clinic with the chief complaint of sexual failure in wedding night and in whom organic causes had been excluded.

Results: The commonest age of patients were between 25-29 years (55%) , most of whom were educated below secondary school(57%), unskilled worker(58%) and from rural area (73%). 50% of them were presented more than one month. The commonest fear was fear of failure (67%) and the commonest sexual dysfunction was erectile failure (90%). 72% of patients contributed their problem to witchcraft, evil eye and jinn possession, while 7% of them contributed their problem to psychological causes. 22% of patients had previous history of consultation with non psychiatric physician for their problem, while 67%of them had previous history of contact with healers.73% of patients, their marriage were traditionally arranged and most of couples (75%) had rarely contact during engagement. 88% of patients had spent their wedding night at their primary family home,13% of them had foreplay before intercourse and only 3% had previous past sexual experience.

Conclusion: Men sexual dysfunction caused by the interaction of multiple factors, mainly psychological, social, cultural and educational level.

Background and objective: Gingivitis is the most prevalent oral problem associated with pregnancy, in addition to several salivary changes. This study was designed to find the effect of pregnancy on salivary chemical factors (calcium and magnesium concentrations) and flow rate, and compare the results with that of non-pregnant women.
Methods: The samples consist of (118) females with age ranged from (20– 40) years (84 pregnant and 34 control, non-pregnant women). After collection of un stimulated saliva, the concentration of calcium and magnesium, and salivary flow rate were measured.
Results: The means of salivary flow rate, calcium and magnesium concentrations of pregnant and non-pregnant women were statistically non significant. There were non-significant difference between the means of each parameter with the age group of pregnant women and the gestation age. Non-significant difference between the means of each parameter with the trimester of pregnancy.
Conclusion: All factors showed non-significant differences between pregnant and non - pregnant women.

Background and objective: The transmission of oral pathogens to impression and subsequently on to gypsum casts had been demonstrated. The aim of the study to investigate the effect of disinfections of type III dental stone casts by spraying and immersion in 70% hospital sprit (ethanol) on the compressive strength and surface roughness at two different time intervals (24 and 48) hours.

Methods: Forty eight cylindrical stone specimens (12 for each group), were prepared for compressive strength and surface roughness testing. Six specimens of each group were tested after (24) hours and the other six after (48) hours.

Results: The study showed no significant differences in values of compressive strength and surface roughness between the control and sprayed groups at (24 and 48) hours, this could be due to the fact that the sprayed specimens absorbs fewer amounts of disinfectants than the immersed groups.

Conclusion: The immersion of the specimens in (70%) ethanol for (10) seconds and (30) minutes decrease the compressive strength and increase the surface roughness.

Background and objective: Calcium hydroxide used in modern root canal therapy as intra-canal dressing. It is used due to its antimicrobial effect. In this study trhree different techniques of placing calcium hydroxide as intra-canal dressing are used to determine the most effective method of using calcium hydroxide as intra-canal dressing.

Methods: Eighteen mandibular premolars were randomly collected, root prepared and filled with calcium hydroxide paste in one of three techniques (1) using file and absorbent paper point with vertical compaction (2) using special syringe with vertical compaction (3) using lentulo drill with vertical compaction. Radiographs were taken to evaluate paste compactness.

Results: The placement of calcium hydroxide with lentulo drill aided by vertical compaction showed the lowest number of empty spaces followed by using special syringe with vertical compaction and the highest number of empty spaces was shown by using file aided by absorbent paper point and vertical compaction.

Conclusion: The use of lentulo drill aided by vertical compaction gave the best result of using calcium hydroxide paste as intra-canal dressing.

Background and objective: To study the correlation between etiology, sex, side and time of TMJA, to evaluate and compare two different surgical techniques and their postoperative complications.

Methods: Twenty-one patients (15 female , 6 male) were treated in Rizgary Teaching Hospital in Hawler during the period May 2007-October 2008. The patients were referred from Hawler and Duhok governorates, and operated on by two surgeons each adopted one surgical technique, either gap arthroplasty with temporalis muscle flap (technique A) or horizontal ramus osteoctomy with masseter muscle flap (technique B).

Results: We found 95.65% of patients had TMJA before the age of ten years and 96% was due to trauma (57% was bilateral TMJA and 43% unilateral), technique (B) was easier and of shorter duration than technique (A) which was more functional. The most common postoperative complication was neural deficit (33.33%). Anterior open-bite occurred in 36.3% of patients with bilateral ankylosis.

Conclusion: The earlier the onset of ankylosis, the more the extent of deformity and the more complicated surgical technique was required. Both techniques were effective with good immediate out come.