Print ISSN: 0027-1446

Online ISSN: 2309-6217

Main Subjects : Surgey

Intra-gastric balloon, an aid for weight reduction in an obese patient

nashwan mahgoob

Annals of the College of Medicine, Mosul, In Press
DOI: 10.33899/mmed.2019.125957.1006

Background: To evaluate safety, tolerability, and efficacy of MedSil intragastric balloon for patients with class one and two obesity.
Methods: From January 2015 to January 2017, MedSil intragastric balloons were inserted in stomachs of 85 patients. All the patients had a body mass index between 30 to 39 kg/m2 and were within the age range of 17-50. There were 55 female and 30 male, the patients underwent consent, pre balloon insertion investigations and anesthesia evaluation. The balloon was inserted via an upper endoscopy after diagnostic study; it was filled with 550-600 milliliters of methylene blue stained saline. All patients' were received analgesic and antiemetic for a week and proton pump inhibitors for 6 months after the procedure, the patients followed a program protocol included diet and exercise. The balloon was removed after 6 months. The patients were followed during the period of insertion and 6 months after the retrieval of the balloon. The weight reduction and complications were reported.
Results: Satisfactory weight loss was obtained in 85% of patients after 6 months and 75% after 12 months from insertion respectively. One patient underwent early removal of the balloon; other patient had balloon leak which necessitated replacement. Early postoperative pain and vomiting were universal but subsided in 90% during the first 10 days.
Conclusion: The intragastric balloon can be effective to achieve weight loss with low complications in stage one and two obesity.

Descriptive Study of Colorectal Cancer in Iraq, 1999-2016

Taha HT Al-Saigh; Shahbaa A Al-Bayati; Shatha A Abdulmawjood; Faris A Ahmed

Annals of the College of Medicine, Mosul, Volume 41, Issue 1, Pages 81-85
DOI: 10.33899/mmed.2019.161330

Background: Colorectal cancer has increased in the last decades, which constitutes about 10% of cancer mortality. It becomes the second and third most common cancer in women and men respectively.
Objective: To explore the factors for colorectal cancer in Iraq including age, gender, family history, diabetes, smoking, serum carcinembryonic antigen (CEA) as a predictor factor, stages of cancer, bowl habit, and symptoms.
Patients and methods: This study was conducted in surgical unit at Alkathymia Teaching Hospital, Baghdad and in Al-Jammhory Teaching Hospital, Mosul, during the period from Feb-1999 to June-2016. This is a case series study for 956 patients with colorectal cancer. The data gathered included: age, gender, family history, diabetes and smoking, serum CEA, stages of the disease, bowl habit and symptoms. Data are presented as mean and percentage, and were analyzed by using Chi square goodness of fit test.  p values ≤ 0.05 were considered significant.
Results: Colorectal cancer patients with ages between 25-50 years were significantly (p≤0.01) higher than the patients with > 50 years or 5 ng/mL presented the high percentage (83.6%) and they were highly significant (p ≤ 0.001) than patients with serum CEA less than 5. Stage 2 (48.2%) was significantly (p≤0.01) higher than stage 1 (16.6%), 3 (20.6%) and 4 (14.5%), respectively. For bowl habit, constipation presented 75.8% was significantly higher than diarrhea (14.5%). In addition, symptoms of bleeding per rectum (71.1%) were significantly higher than symptoms of pain (28.2%).
Conclusion: Colorectal cancer is significant disease in Iraq. Middle age patients presented the highest percentage. Education of patients about bowl habit and symptoms of colorectal cancer should be applied especially constipation and bleeding per rectum.

Parathyroidectomy under Local Anesthesia: A Case Report

Khalaf Allwayzy; Mahmood A Aljumaily

Annals of the College of Medicine, Mosul, Volume 41, Issue 1, Pages 91-94
DOI: 10.33899/mmed.2019.161332

A fifty four years old lady presented with severe generalized bone pain, having history of multiple fractures for the last two years, biochemical tests proved to be primary hyperparathyroidism and parathyroid adenoma localized with ultrasonography. Parathyroidectomy was carried out under local anesthesia, and the patient improved dramatically after surgery.

Glycosylation Gap in Gallstone Patients

Ahmed T. Hamed; Muzahm Al-khyatt; Muhammad A. Alkataan; Israa Al-banaa

Annals of the College of Medicine, Mosul, Volume 41, Issue 1, Pages 86-90
DOI: 10.33899/mmed.2019.161331

Background: Gall stones are one of the commonest biliary diseases. Interest in the formation and clinical management of the disease dates back to ancient times. Gall stones continue to be one of the major health problems in the world today, although the exact number of patients is unknown, because there are no signs and symptoms related to the disease when there are no complications. The majority of the patients are diagnosed incidentally. However, some patients come with acute complication of gall stones. Gall stones are classified into; cholesterol gall stones, pigment gall stones, and mixed gall stones. However, all stones even pure cholesterol gall stones usually contain bilirubin (conjugated and unconjugated bilirubin) and cholesterol.
Aim: To determine the changes in glycosylation gap and glycation profile and the relation of this change to the changes in age and BMI on the measured parameters.
Patients and methods: Serum samples were collected from 40 individuals included in this work. They are divided into 2 groups. The first group included 20 apparently healthy individuals (10 males and 10 females). The second group included 20 individuals (5 males and 15 females) with Gall stone diagnosed in out-patient Clinic at Al-Jamhoory General Hospital and Neinawa private Hospital. Gall stone patients with metabolic diseases, infections and other inflammatory diseases were excluded.
Results: The study demonstrated a significant elevation in serum glucose, mean blood glucose, serum fructosamin, measured and predicated HbAc1 in GS patients in comparison with controls. Regarding the relation between age and measured parameters, the study showed a non-significant correlation between age and measured parameters in the control group, while in GS group there were a significant correlation (r = 0.05) between ages and predicted HbAc1 and BMI (p ≤ 0.03). Regarding the relation between BMI and measured parameters, the study showed a significant correlation between measured parameters and BMI in GS individuals, while in control group only serum glucose and MBG in control group (r = 0.01) (p ≤ 0.01) with MBI.
Conclusion: The study shows that there is a significant change in glycosylation gap and glycation profile in gall stone patients.

The Relationship between Cardiopulmonary Exercise testing (CPET), other Related Factors and Outcomes in Patients Undergoing Major Upper Gastrointestinal Surgery

Janan Alrefaee; Donald McMillan; Roger Carter; Jane Nally

Annals of the College of Medicine, Mosul, Volume 41, Issue 1, Pages 1-10
DOI: 10.33899/mmed.2019.161246

Background: Assessment of patient’s fitness prior to major surgery is mandatory because co-morbidities predispose to postoperative complications; however the ability of pulmonary function tests to predict postoperative cardiopulmonary complications is still poorly defined.
Objective: to examine the role of preoperative measurements of cardiopulmonary exercise testing and other lung function tests in predicting postoperative outcomes in patients undergoing major upper gastrointestinal surgery (stomach, oesophagus, small intestine, gall bladder and pancreas surgery).
Patients and methods: A 193 patients who had major upper gastrointestinal surgery’ age, sex and smoking status were recorded and they underwent a range of tests including body mass index, flow-volume curve spirometry, blood gas analysis, transfer factor for carbon monoxide (TLCO) and CPET at the Pulmonary Function Laboratory of Glasgow Royal Infirmary between August 2008 and December 2011. Post-operative morbidity and mortality was analysed for all patients who underwent major surgery.
Results: Comparisons between patients that did or did not have post operative pulmonary complications showed significant differences in anaerobic threshold as % predicted maximum oxygen consumption during exercise (VO2; p<0.05), length of high dependency care stay (p<0.001), length of ward stay (p<0.01) and length of hospital stay (p<0.001).  There were significant differences between those patients with and without operative anastomotic leak in body mass index (BMI; p<0.05), length of high dependency care stay (p<0.001), length of ward stay (6 vs.15, respectively; p<0.001), length of hospital stay (14 vs. 28, respectively; p<0.001) and duration between date of surgery and date of commencing postoperative chemotherapy (p≤0.01). 
Conclusion: CPET and in particular anaerobic threshold % maximum predicted is useful in predicting the likelihood of the development of pulmonary complications in patients undergoing upper gastrointestinal surgery.

Isolated Sphenoiditis, Hidden Cause of Headache

Saad Y. Sulaiman

Annals of the College of Medicine, Mosul, Volume 41, Issue 1, Pages 36-42
DOI: 10.33899/mmed.2019.161333

Background: Many patients present to otorhinologists daily complaining of headache due to rhinosinusitis which generally has a specific findings. Nonetheless, isolated sphenoiditis is a rare type of sinusitis, but associated with more serious complications due to its contiguity with vital intracranial structures, and is usually associated with non-specific findings that may be missed as a cause of headache.
Objectives: To highlight cases with headache due to isolated sphenoiditis that present with non-specific signs and symptoms of sinusitis, and to discuss the best methods of diagnosis and treatment to avoid serious complications.
Patients and methods: A case series study of 27 patients (21 males, 8 females) aged between 18-32 years-old (mean age 25 years old), were evaluated during the period between June 2015 and December 2017 in the author's private clinic at PAR Hospital, Erbil, Iraq. Those patients were misdiagnosed as cases of primary headache (migraine or tension-type headache). The diagnosis of isolated sphenoiditis in those patients was based on clinical findings, nasal endoscopy and it was proved by computerized tomography scan.
Results: The study was performed on adult patients, half of them were between 24-28 years-old, with a male to female ratio of 7:3. Headache was the presenting symptom with minimal expression of other symptoms of sinusitis, i.e.; nasal obstruction in 10 patients (37%), postnasal discharge in 5 patients (18.5%), visual symptoms in 3 patients (11%) and sneezing and itching in 6 patients (22%). Nasal endoscopic findings were negative in 5 patients (18.5%), while septal deviation was noted in 14 patients (52%), concha bullosa in 1 patient (3.7%), postnasal discharge in 5 patients (18.5) and granular pharyngitis in 10 patients (37%). Computerized tomography scanning of the paranasal sinuses was performed for all patients and proved the diagnosis of isolated sphenoiditis. Headache was relieved by medical treatment in 22 patients (81.5%). Five patients (18.5%) required surgical treatment.
Conclusion: Although it is uncommon, isolated sphenoiditis must be suspected in patients with headache. It is a potentially dangerous disorder due to the contiguity of the sinus with vital neuro-vascular structures. Therefore, ENT specialists must be alert of this rare condition and radiological examination of paranasal sinuses should always be performed in prolonged and intractable cases of headache. Computerized tomography scan is the best tool in diagnosis and follow up of such cases.