Homozygosity for the Mediterranean alpha-thalassemic deletion [hemoglobin Baits hydrops fetalis]

Hemoglobin Barts hydrops fetalis syndrome is the most severe and generally fatal clinical phenotype of alpha-thalassemia. We diagnosed a fetus at 23-weeks gestation with having hydrops fetalis, by ultrasound. At 32 weeks, intrauterine death was detected. Molecular studies revealed that the fetus had the hemoglobin Barts hydrops fetalis syndrome due to homozygosity for the Mediterranean alpha-thalassemia deletion. This clinical phenotype is generally rare in the Eastern Mediterranean, and this is the first report of this syndrome from Iraq. Techniques for molecular characterization became available only very recently in this country, in a diagnostic setting. Thus, the detection of further cases might be expected in future

Complications of thyroid surgery the effect of surgical procedures

Complications of thyroid surgery had low incidence but are sometimes serious. Haemorrhage with its serious results, recurrent laryngeal nerve injury and hypocalcemia are known complications. To study the post-operative complications in our collection of thyroid surgery with the strict use of the individual ligation of the superior thyroid vessels and the nonligation of the inferior thyroid artery and to compare our results with those of the literature. Over 10 years from Jan. 1995 to Dec. 2004, three hundreds and seventy patients were operated on for thyroid diseases by the author. They were studied with regards to the indications, type of procedures and postoperative complications. Strict practice of individual ligation of vessels of the superior thyroid pedicle and nonligation of the inferior thyroid artery was used in all procedures. Identification of the recurrent laryngeal nerve was practiced in extensive goiter, total and near total thyroidectomy. The final diagnosis of these operated upon cases were; non-toxic multinodular goiter [222], toxic goiter [70], papillary carcinoma [27], follicular carcinoma [15], follicular adenoma [14] and thyroiditis [22]. Procedures done were as such; bilateral subtotal thyroidectomy [181], lobectomy with or without isthmectomy [82], right subtotal thyroidectomy [37], left subtotal thyroidectomy [25], near total thyroidectomy [27] total thyroidectomy [16] and total thyroidectomy with modified radical neck dissection [2]. Complications recorded in the post-operative period were; injury to external laryngeal nerve [1], unilateral recurrent laryngeal nerve [1], temporary hypocalcemia [2], subcutaneous hematoma [3], major infection [2], minor infection [12], sinus [5], recurrent toxicity [3] and recurrent nodularity [8]. There was no mortality in this collection. To reduce thyroid surgery complications, we recommend the use of strict technique of individual ligation of the superior thyroid pedicle vessels and nonligation of inferior thyroid artery

Primary plasma cell leukemia occuring in the young.

Plasma Cell Leukemia (PCL) is a rare form of plasma cell dyscrasia. Plasma cell leukemia has two variants: the primary form presents de novo in patients with no previous history of multiple myeloma (MM); the secondary form consists of a leukemic transformation in a previously recognized MM. In contrast to myeloma, PCL has an aggressive course. Median age at presentation is usually above 50 years. Here we report a case of primary PCL presenting at age of 21 years, which is extremely rare. She was treated with combination chemotherapy (VAD). Although she had a good response initially, later the disease progressed and she died 6 months after the diagnosis.

Penetrating and blunt diaphragmatic injuries

The purpose of this study is to analyze the ruptured diaphragm retrospectively in regard to mechanism of injury, diagnosis and treatment; and to discuss the difficulties in their diagnosis. Thirty patients were included in the study and the study was carried out at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, over a 9 year period [1992-2001]. Their demographic data, diagnosis and treatment were recorded. Twenty-one patient had civilian penetrating injuries, while 9 suffered blunt trauma. Young males were the predominant victims. Three cases of the blunt trauma group had a delayed diagnosis, [2 after repeated chest radiography and one after Ba meal]. The preoperative diagnosis of diaphragmatic injuries is difficult. Most cases are diagnosed during exploration for associated injuries. The case is more difficult after blunt trauma. Repeated chest radiography and gastrointestinal contrast studies can be used for the diagnosis

role of fine needle aspiration cytology in the diagnosis of breast masses

To study the accuracy of fine needle aspiration cytology [FNAC] in the diagnosis of breast masses in Iraq. 127 patients who presented with breast mass over a 2 year period [Oct 1998 - Oct 2000] underwent FNAC as well as excisional biopsy in order to compare the results. There were 121 females and 6 males, with the total of 79 benign lesions [62.2%] and 48 malignant lesions [378%]. Of the 80 patients who had benign results on FNAC, 3 were false negative. All 41 patients who had malignancy on FNAC had malignant histopathology. Of the 6 who had suspicious FNAC results, 2 were benign [2 false positive cases] and 4 were malignant on histopathology. The sensitivity of the test was 93.7% and the specificity was 97.5%. The accuracy rate was 96%. There were no serious complications to the procedure. The most common benign lesion was fibroadenoma [47%]. The most common malignant lesion was infiltrative ductal carcinoma [83.3%]. FNAC of breast masses was found to be a safe and inexpensive procedure as well as a sensitive and specific diagnostic tool

unusually delayed systemic anaphylactic reaction to iodinated contrast media

Delayed reactions to iodinated contrast media are rare. Even more rare are delayed systemic anaphylactic reactions. A case of a delayed systemic anaphylactic reaction to sodium iothalamate is presented which highlights the importance of keeping patients under observation for at least 1/2 an hour after being given conventional contrast media intravenously

Is there over utilization of chest radiography at the primary health care level in Bahrain

It had been our impression that there was over utilization of x-ray particularly chest radiography, at the primary health care level in Bahrain. Accordingly, we studied the chest radiographs of a health centre's patient population [Shaikh Sabah Health Centre] over a period of 6 months [Jan-June, 1986]. Out of the 291 chest radiographs studied only 45 [15.46%] were positive. Therefore, strict criteria for chest radiography should be established locally to minimize the cost of patient care and to reduce radiation dose to the general population

Endoscopic management of upper urinary tract stones: one year experience

During the one year period ending November 1st, 1987, 241 patients had endoscopic upper tract stone removal by either percutaneous nephrolithotomy [PCNL] or by transurethnal ureteroscopy, or as the primary modality of therapy. Successful stone extraction by PCNL was achieved in 146 out of 150 patients [97.3%], and by ureteroscopy in 83 out of 91 patients [91.2%]. Some of the patients had 2 or more stones removed. 9 ureteroscopies were performed to push stones to the kidney for percutaneous removal. Complications have been very few as has been the morbidity. The mean hospital stay was 6 days with a quick return to work

Heterotopic gestation: a case report and review of the literature

A case of heterotopic gestation is described after clomiphene therapy. Following the removal of the ectopic the intrauterine pregnancy continued uneventfully until term. A short review of the literature is made here with particular reference to the predisposing causes, and to the difficulties encountered in making early and accurate diagnosis of heterotopic gestation. We would like to draw attention to the advantages of combining ultrasonography and early laparoscopic intervention for making a definite diagnosis. Routine curettage in cases of "rule-out ectopic" laparoscopy procedures may result in an inadvertant evacuation of a wanted pregnancy