Risk factors of breast cancer in a sample of Kurdish women of Kurdistan Region - Iraq: a comparative study between pre-menopausal and post-menopausal women

To evaluate the difference between pre- and post-menopausal breast cancer regarding menstrual and reproductive risk factors for ca breast.. A prospective case-control study was conducted in Nanakaly Oncology Hospital in Erbil city-Kurdistan- Iraq, between September 2009 and April 2011. Cases were breast cancer patients admitted in the oncology floor of the hospital. Controls were hospital patients without breast cancer [other cancers]. The study enrolled 300 cases and 600 controls. Menstrual and reproductive history was taken from both the cases and the controls. For every risk factor age-adjusted odds ratio [OR] and 95% confidence interval [CI] was calculated by logistic regression analysis, separate for pre- and post-menopausal women. Among the breast cancer patients, 42.7% were pre-menopausal and 57.3% were post-menopausal. Age at menarche had no association with breast cancer for both pre- and post-menopausal women. Nulliparity was a risk factor for both pre-menopausal [OR = 2.42, 95% CI [1.1-4.6] and post-menopausal breast cancer [OR = 3.7, 95% CI [2.04-6.87]]. Among parous women only post-menopausal females having <3 children were at in-creased risk for breast cancer [OR = 2.18, 95% CL [1.45-3.27] compared with females having > 3 children. Younger age at first live birth decreased breast cancer risk in both pre- and post-menopausal women. Breastfeeding was not associated with both pre- and post-menopausal breast cancer. Majority of risk factors for pre-menopausal breast cancer are also associated with post-menopausal breast cancer except less parity, which increased the risk for post-menopausal breast cancer only

Predictive clinical factors, diagnosis, and management of intrabiliary rupture of a hepatic hydatid cyst in Erbil Teaching Hospitals, Erbil province-North Iraq

This study investigates the clinical factors associated with an intrabiliary rupture of a hepatic hydatid cyst for early diagnosis and management of cystobiliary communications in patients with liver echinococcosis and presents our experience with this condition. A prospective study included patients with hepatic hydatid cysts treated between years 2000 and 2007 in a single institution, Erbil Teaching hospital Erbil province-Iraq. Database containing 121 patients with a hepatic hydatid cyst were reviewed. The following variables were analyzed as potential predictors of an intrabiliary rupture: age, sex, type, duration of symptoms, findings on physical examination, leukocyte count, liver function test results, serologic test results, suggestive ultrasonographic findings, ltrasonographic cyst features [type, diameter, number, and localization], and whether the cyst is primary or recurrent. Multivariate analysis showed that the independent clinical factors for the presence of an occult rupture were a history of gastric upset in the form of nausea and vomiting [p=0.004], alkaline phosphatase level greater than 140 U/L [p=0.004], total bilirubin level greater than 0.7 mg/dL [>13.5 micro mol/L] [p<0.001], and cyst diameter greater than 14.5 cm [p<0.001] in multivariate analysis. Multivariate analysis also showed that history of jaundice [p<0.001], jaundice found on physical examination [p=0.05], cyst diameter greater than 10.5 cm [p=0.009], a type IV cyst [p<0.001], and suggestive ultrasonographic findings [p<0.001] were the independent clinical predictors for the presence of a frank intrabiliary rupture. Patients with cystobiliary communications had increased morbidity rates to 47.8% of 23 patients vs. 9.9% of 98 patients [p<0.001], and longer mean postoperative hospital stays [11.5 versus 8.4 days; p=0.03] compared with others. Clinical predictors should be considered for early diagnosis and proper management of intrabiliary ruptures in patients with hepatic hydatid cysts, since a frank intrabiliary rupture of hepatic hydatid cyst is a rare but serious event, and one should be aware of it in differential diagnosis of obstructive jaundice. Patients with cystobiliary communications had increased morbidity rates

Causes of intestinal obstruction in Erbil teaching hospital province-north of Iraq

Bowel obstructions are not uncommon should be suspected in any patient with persistent vomiting, distention, and abdominal pain because delayed diagnosis and treatment can have devastating consequences. Undiagnosed or improperly managed obstructions can lead to vascular compromise, which causes bowel ischemia, necrosis, perforation, sepsis, and death. The object of this study is to focus attention on the causes of intestinal obstruction and the role of abdominal radiographs and imaging in the diagnosis and operative procedures undertaken. The study was conducted at the Department of Surgery, Erbil Teaching Hospital Erbil province [2.5 million populations] -Iraq, between years 1996 and 2005 inclusive. A prospective study was carried out spread over 10-years, and involving 591 patients with intestinal obstruction, among them only 570 patients underwent operations included in this study and 21 patients with conservative management had been excluded. Of the 570 patients with intestinal obstruction, 41 Iwere male patients [72.1%] their mean ages were 51.25% and 159 were female patients [27.9%] their mean ages was 39.8%. The most common cause was the entrapment of bowel in an external hernia [30.7%]. Postoperative adhesions accounted for obstruction in a third of our patients [28.7%], and [59%] of them followed appendectomy. The operative findings of all patients who presented obstructed hernias still account for the highest percentage of cases. Other minor causes constitute the rest of cases. All 570 patients with the diagnosis of IO underwent surgical procedures in 68 patients [11.9%] who developed serious complications in the form of Sepsis, Intra-abdominal abscess, Wound dehiscence, Aspiration, Short-bowel syndrome [as a result of multiple surgeries] Forty patients died [7%] mostly because of irreversible shock, pulmonary embolism, and multiorgan failure entrapment of bowel in an external hernia and adhesions remain the leading causes of acute intestinal obstruction in our environment. Sustained efforts at elective repair of hernias and research aimed at reducing adhesions are likely ways to reduce the high mortality from intestinal obstruction

Surgical treatment of hyperthyroidism in the north of Iraq: reduction in mortality and morbidity with a planned approach. Results of 544 operations with special reference to pre-operative treatment with carbimazole and thyroid hormones

To reduce mortality and morbidity to the lowest levels by a planned preparation of the patient for operation; treatment must be individualized and depends on the patient's age and general state of health, the size of the goitre, the underlying pathological process, and the patient's ability to obtain follow-up. A prospective study. Erbil Teaching Hospital [University Hospital] during the period from January 1994 to September 2004, Erbil-Iraq [population 2 million]. 632 patients with hyperthyroidism. All patients with hyperthyroidism [632] presenting to the department of surgery at Erbil teaching hospital during the period from January 1994 to September 2004; 544 were treated surgically and 88 were treated medically and with radio-iodine. Side effects of the anti-thyroid treatment [Thiocarbamide] were observed in 42 cases [7.7%]. Most patients were treated for an average of between 1 to 6 months. Thus it was possible to operate on the patient at a time suitable for the patient, surgeon and hospital. Carbimazole was the most frequently used anti-thyroid drug in Erbil Teaching Hospital. Surgery resulted in rapid cure of hyperthyroidism in 90% of patients and allowed for rapid relief of compressive symptoms. Frequency of hypothyroidism was similar to that of those treated with radioiodine [15.5%]; 10% developed recurrent thyrotoxicosis [p > 0.054]. Complications included permanent vocal cord paralysis [2.3%], permanent hypoparathyroidism [0.5%], temporary hypoparathyroidism [2.5%], and significant postoperative bleeding [1.4%]. The mortality rate was almost zero. Surgical therapy, in this study, was reserved for young individuals, patients with a large nodule [or nodules] or obstructive symptoms, patients with dominant non-functioning or suspicious nodules, patients who were pregnant, patients in whom radioiodine therapy had failed, or patients who required a rapid resolution of the thyrotoxic state. Sub-total thyroidectomy resulted in rapid cure of hyperthyroidism in 90% of our patients and allowed for rapid relief of compressive symptoms. This planned approach showed that the mortality rate between the years 1985 to 1993 was 7%, while the mortality rate reduced almost to zero between 1994 to 2004; the morbidity was reduced from 17% to about 4% during the same period

Surgery of liver hydatidosis with and without albendazole

Hepatic hydatidosis still remains a serious problem in general surgery. Recurrence and/or secondary hydatidosis rates are up to 25% in the cases treated with surgery alone. Albendazole is the most commonly used drug in the dual treatment of echinococcosis. To evaluate the effect of albendazole using the intraoperative and perioperative periods as dual therapy on recurrence of echinococcosis. Eighty-eight patients with hydatid disease who were operated upon for hepatic hydatid cysts between 1[st] of March 1998 and 31[st] of July 2006, in the Surgical Department of Erbil Teaching Hospital in Erbil City, Iraq, are included in this study. The patients were divided into two groups. The first group was treated with albendazole peri- and intra-operatively with surgery while the second [comparison] group was treated surgically alone and without albendazole. Peri-operative albendazole treatment was given in a dose of 12-15 mg/kg/day in four divided doses. The treatment was started 2-28 days before the surgery when the diagnosis was established and was continued for one month. Thirty six per cent of scoleces were viable in the treated group, while 80% of scolices were viable in the second [comparison] group [P < 0.005]. In the second [comparison] group there were four patients with sterile cysts and 15 patients with fertile and viable cysts but with no daughter cysts. In the treated patients there were only 3 [9%] with recurrent cysts that developed in the previous surgical field, compared with the second [comparison] group, where there were 13 patients [24%] who developed recurrent cysts. Dual albendazole treatment is effective in the prevention of recurrences and/or secondary hydatidosis