Hepatocellular carcinoma presentation and management, a prospective study in the medical city Baghdad-Iraq

The development of HCC is a major global health problem. It's incidence has increased world wide and nowadays it constitute the 5[th] most frequent cancer representing around 5% of all cancers, and estimated to rank 4[th] 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 and hereditary causes of cirrhosis have a strong correlation with HCC . HCC is a highly malignant tumor with poor prognosis. To evaluated the Etiological, Epidemiological, Patho physiological, Diagnostic series, Therapeutic approaches and Advanced studies in detection and prevention of HCC. 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 and surgical units of Baghdad teaching hospital and the gastroenterology and hepatology teaching hospital. History taken from these patients and 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. 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 and [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%] and 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 and Right lobectomy [3.5%] for each, Debulking [9%]. 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

effect of ramadan fasting on duedenal ulcer perforation

Fasting during the month of Ramadan is one of the five holy pillars in the Islamic faith and is an important annual ritual practiced by all Muslims. This involves fasting from dawn to dusk, followed by a break of fast at designated times. The length of fasting varies from ten to 19 hours, depending on the season in which the fasting month of Ramadan falls and the geographical locations. 1st to evaluate the relation between Ramadan fasting and duodenal ulcer perforations and 2nd to asses the risk factors of this complications. This is a prospective study in Baghdad Teaching Hospital - Medical City . Data from 231 consecutive patients with perforated duodenal ulcer from the period of October 2007 to December 2010 were collected and analyzed and all the patients were managed surgically after resuscitation in emergency unit. [96/231, 41.6%] of patients with perforated duodenal ulcer during Ramadan vs. [135/231, 58.4%] during the rest of the years. [96/490, 19.5%] of patients with perforated duodenal ulcer from the total number of all patients with acute abdomeninal surgeries during Ramadan. 43% of patients smoking and 47% of patients had a previous history of acid peptic disease in Ramadan. 54% of patients were in between [20 to 40] years age group and the male to female ratio was 6 :1 . 15% patients of perforated duodenal ulcer had history of regular use of non steroidal anti inflammatory drugs.. Erect chest x-ray demonstrated gas under the diaphragm in 86% . Only 2 patients had a previous surgery of duodenal ulcer perforation. This study suggests that the incidence of duodenal ulcer perforation is relatively high in Ramadan among the people, who are fasting and have predisposing factors [smoking, history of acid peptic disease, non steroidal anti-inflammatory drugs] and need special precaution during this month