Abstract: Objective: Venous invasion is stage independent prognostic risk factor for distant metastasis in colorectal cancer. Elastic stain is among the various ancillary techniques that were described to increase the sensitivity of detection of vascular invasion. This combined prospective and retrospective study is aimed to assess the sensitivity of elastic tissue stain to detect venous invasion in comparison to the routine H & E stained sections, and to correlate intramural and extramural venous invasion with the Dukes staging system. Method: Serial sections from 42 cases of colorectal cancer diagnosed between the years 2007 and 2009 were examined by using H & E and Weigert's stain. A comparison was drawn between the two stains in regard to venous invasion; the results were correlated with Dukes stage for colorectal cancer. Results: The mean age of sampled patients was 50 years. Venous invasion was detected in 16 (38%) cases by the use of H & E stain, which was increased to 35 (83%) cases by the use of Weigert's stain for elastic tissue with a clear statistical significance (P

Abstract: Background: Iraq is the most affected country by injuries of improvised explosive devices (IED) including bomb car, bomb born on person and roadside bombs. Embedded fragments and shells can release heavy metal. High level of heavy metal in serum carries dangerous long term risk for injured patients. Objective: The aim of this study is to estimate the serum level of heavy metals (copper, lead, cadmium, nickel, and zinc) in patients with fragments and shells from IED including bomb car, bomb born on person and roadside bombs. Material and methods: Serum concentrations of heavy metals (copper, lead, cadmium, nickel, and zinc) were assayed using atomic absorption spectrophotometry in 52 patients with fragments and shells from IED. Serum concentrations of heavy metals were measured in 52 healthy adults as control group. Results: The mean serum level of copper, lead, cadmium, nickel, and zinc in patients were 1304 ± 258.1 µg/L, 36.5 ± 16.7 µg/L, 6.203 ± 2.372 µg/L, 0.387 ± 0.183 µg/L, and 1651 ± 532 µg/L respectively, while in control were 824.2 ± 203.6 µg/L, 31 ± 15.1 µg/L, 1.654 ± 0.4 µg/L, 0.239 ± 0.028 µg/L, 619 ± 234 µg/L respectively. The differences in serum copper, lead, cadmium, nickel, and zinc between patient and control is highly significant, (P value < 0.0001), while the differences in serum lead between patient and control is not significant ( P value > 0.05). Conclusion: The present study demonstrates that a highly significant increase in serum level of copper, cadmium, nickel, and zinc in patient with fragments and shells from IED in comparison with control group, while the difference in serum lead in patients and control was not significant. Keywords: Improvised explosive devices, fragment, shell, metal, serum level.

Abstract: Objectives: To measure serum magnesium concentrations in patients with type 2 diabetes on glibenclamide, metformin or a combination of both drugs therapy in Mosul city. Patients and Methods: One hundred type 2 diabetic patients formed the patients group. Another group of 27 non diabetic healthy individuals involved in the study as a control group. The patients’ group was divided into 3 subgroups according to the type of the oral hypoglycemic agent used (metformin, glibenclamide, metformin plus glibenclamide). The study was conducted in Al Wafaa Diabetes Center in Mosul city, and departments of Pharmacology and Biochemistry, College of Medicine during the period from May 2009 to May 2010. Design of the study is case control. Quantitative analysis of magnesium and glucose in serum were done by using commercial kits. Results: The results showed a significant lower concentration of magnesium of the patients as compared with the controls and a significant higher serum glucose concentrations of the patients as compared with the controls. Conclusion: This study demonstrated that low magnesium status is common in type 2 diabetics who were on therapy with the hypoglycemic agents, metformin, glibenclamide or a combination of both drugs, in Mosul city. Keywords: Magnesium, type 2 diabetes mellitus, glibenclamide, metformin.

Abstract: Objective: The aim of this study was to evaluate the effect of the daily oral adminstration of vitamin D, calcium, fluoride and vitamin C as dietary supplementation on bone healing in experimental animals (rabbits). Material and methods: Eight young male rabbits divided into two groups after induction of open ulnar osteotomy, the experimental group received daily dose of vitamin D, calcium, fluoride and vitamin C as dietary supplementation from the second post operative day for 28 days. The control group received ordinary diet without any food supplementation. At the end of the fifth week, the animals were sacrificed and the specimens taken for radiological and CT scan densimetry, and histological evaluation carried out for calluses at site of osteotomy. Results: All ulnar bone osteotomies in both groups united at the end of the fifth week macroscopically and radiologically. There was no significant difference in serum calcium, phosphate, and alkaline phosphatase preoperatively, and at the end of the fifth week. The callus density was measured in site of osteotomy by CT scan densimetry and its mean in experimental group was 331.1 ± 81.3, and control group was 199.7± 32.1. The difference between the experimental and control group was highly significant, (P value is < 0.001). The histological examination of the bone at site of osteotomy showed healing with woven bone predominantly and some lamellar bone and cartilage. Conclusion: The present study demonstrates that a daily oral administration of vitamin D, calcium, fluoride and vitamin C as dietary supplementation enhance bone healing and increase callus density. Keywords: Vitamin D, calcium, fluoride, vitamin C, dietary supplementation, bone healing.

Abstract: Objectives: Systemic inflammatory response syndrome is one of the most important causes of intensive care unit (ICU) morbidity and mortality worldwide. The aim of this study is to explore the spectrum of diseases responsible for SIRS admission in Mosul, and to identify the mortality rate and the factors associated with poor outcome. Methods: Fifty patients with sepsis or non-infective SIRS were studied during the period from June 1st to November 30th 2009. Patients were collected from the medical ICU and the general medical wards in Ibn-Sina Teaching Hospital in Mosul,. Acute physiology and chronic health evaluation II (APACHE II) score was utilized to assess the severity of illness on admission. The patients included in the study received the standard medical care according to their condition, and were followed to delineate the cause of their illness, the percentage of microbiological confirmation, the duration of hospital stay, the mortality rate and the factors that influence their outcome. Results: Sepsis represented 86% of cases of SIRS, of which 82% of them were caused by community acquired infections. Pneumonia was responsible for 48.8% of sepsis cases, followed by acute pyelonephritis and intra-abdominal infection. Sepsis was microbiologically confirmed in 44.2% of patients, and blood culture was positive in 18.6% of patients. Impaired consciousness, anaemia, hyperglycaemia and high blood urea were associated with excess mortality rate; while positive blood culture and hypoalbuminaemia correlated with high APACHE II score. The overall mortality rate was 44%. Patients with severe sepsis had a mortality rate of 55.2%. Conclusion: SIRS is an important cause of hospital admission in Mosul, with associated high mortality rate. ICU admission should be seriously considered for patients with certain risk factors that predict poor outcome.

Abstract: Objectives: The aims of the present study are; first, to find out the relative frequency of p53 over-expression in different types of breast cancer. Second, to correlate the p53 over-expression with different parameters, including the age and menopausal status of the patient, size, grade, stage, type of the tumor, and the status of axillary lymph nodes. Third, to compare our results with others Methods: The study was both pro and retrospective and included 60 cases of breast carcinoma. Data were obtained from archives of the pathology department, at Al-jumhuri Teaching Hospital and collected in a period spanning from August 2008 to January 2009. P53 over-expression was assessed immunohistochemically . Results: The patients ages ranged from 25 to 78 years (mean: 51.5 year); most of them were in the fourth decade (41.2%). There was a significant inverse relation between p53 over-expression and the age of the patients (p

Abstract: Background: A variety of substances, biological and physical interventions have been used to enhance bone fractures healing. There is growing evidences for the importance of nutrition in maintenance of bone health and support of fracture healing. Objective: The aim of this study was to evaluate the effect of the daily oral dose of concentrated bone broth as dietary supplementation on bone healing in experimental animals (rabbits). Material and methods: Twelve young male rabbits divided into two groups after induction of open ulnar osteotomy, the experimental group receive daily dose of concentrated bone broth as a dietary supplementation. The control group received ordinary diet. In the end of second weeks three animals from both group were killed, at the end of fifth week, the other animals were sacrificed and the specimens taken for radiological and computerized tomography (CT) scan densimetry and histomorphometric evaluation carried out for the callus at site of osteotomy. Results: The ulnar bone osteotomies in both groups were united at the end of the fifth week macroscopically and radiologically. The callus density was measured in site of osteotomy by CT scan densimetry, at the end of 2nd week the difference between the experimental and control group was not significant, (P value > 0.05), and at the end of 5th week the difference between the experimental and control group was highly significant, (P value < 0.001). The histomorphometric evaluation of healing in site of osteotomy carried out, and at the end of 2nd week the difference between the experimental and control group was not significant, (P value > 0.05), and at the end of 5th week the difference between the experimental and control group was significant, (P value < 0.05). Conclusion: The present study demonstrate that a daily oral administration of concentrated bone broth as dietary supplementation in rabbits enhance bone healing by increase callus density in CT, and improve histomorphometric evaluation of healing. Keywords: Bone broth, fracture, healing, and dietary supplementation.

Abstract: Objective: To study the effect of depot-medroxyprogesterone acetate (DMPA) injections on C-reactive protein (CRP) and lipid profile and to find the predictors (body weight, body mass index (BMI), blood pressure (BP) and lipid profile) that significantly predict the risk of cardiovascular disease (CVD) among DMPA injections users. Method: A prospective cohort study was performed during the period from March 2009 to March 2010 included thirty apparently healthy married women, their age ranged between 20-35 years, who were attending Al-Batool and Al-Khansa Family Planning Centers in Mosul and started (for the first time) to use DMPA injections (150 mg medroxyprogesterone acetate), called "Depo-Provera" as contraceptive. These (DMPA users group) were compared to another 30 healthy married women who did not use any hormonal contraceptives (non users group). Both groups were followed for one year, during which blood samples were obtained from both groups, before starting to use DMPA, after 6 months and after 12 months. Sera were used for the estimation of the biochemical studied parameters using commercial kits except serum low density lipoprotein (LDL) and atherogenic index (AI) which were calculated by special equations. Results: DMPA injections caused a non significant increase in body weight but a significant increase in BMI after 12 months. There was a significant increase in the mean diastolic blood pressure (DBP) of DMPA users according to the duration of use. The DMPA caused non significant changes in the CRP levels. There was a significant increase in serum triglycerides (TG) after 6 months of DMPA uses with respect to the duration of use. But there were non significant changes in mean serum total cholesterol (TC), high density lipoprotein (HDL), LDL and AI. Among all variables that were studied, only body weight and BMI showed a significant positive correlations with CRP. Using a stepwise multiple regression analysis, it was found that the predictors that significantly predict the risk of CVD among DMPA users were AI, DBP and TG. Conclusion: This study found that there is a significant positive association between CRP and CVD risk factors in DMPA injections users as contraceptive. Furthermore AI, DBP and TG were found to be significant predictors for the risk of CVD among DMPA users. This study confirmed the safety of DMPA use as contraceptive medication, but that special care should be directed for patients with CVD and other patients who were more sensitive to the harmful effects of lipid in the blood. Key words: Depot-medroxyprogesterone acetate, CRP, lipid profile.

Abstract: Objectives: 1- To evaluate the incidence of Pseudomonas aeruginosa bacterial pathogens in burn patients. 2- To determine the antibiogram profile of Pseudomonas aeruginosa to selected antibacterial agents. 3- To assist their production of β-lactamases. Patients and methods: This study enrolled 90 burned patients including 63 (70%) females and 27 (30%) males. Pus and wound swabs were collected aseptically from these patients and assessed microbiologically. The isolates of P. aeruginosa were tested for their susceptibility to 10 selected antimicrobial agents, and evaluated for β-lactamases using iodometric and double disk approximation methods. Results: Out of the 90 studied patients with second and third degree burns, 60 (66.7%) yielded positive bacterial growth, while 30 (33.3%) were culture negative. From the total 105 bacterial isolates 88 (83.8%) were gram negative and the remaining 17 (16.2%) were gram positive. The predominant microorganism was P. aeruginosa (50%), whereas the least isolated one was Proteus (3.3%).The antibiogram study of P. aeruginosa showed that the least resistance was against piperacillin, while the highest resistance was noted in cases of carbencillin and cefoxitin. Multidrug resistance (MDR) P. aeruginosa formed 44.4% of the total isolates of P. aeruginosa and they had statistical association with ceftriaxone, meropenem, ceftazidime and amikacin consumption. Ninety percent of P. aeruginosa were β-lactamases producer and 10 % of them produced the inducible β-lactamases. Conclusion: The bacteria isolated from Burn Units are the best examples for the study of pathogenic bacterial species, specially Pseudomonas aeruginosa, other enteric bacilli and Staph. aureus which frequently responsible for human colonization. Also, Pseudomonas aeruginosa and other gram negative bacilli are frequently associated with nosocomial burn infection. Furthermore, most isolates of P. aeruginosa from Burn Units are β- lactamases producers and most of these isolates were MDR pseudomonas aeruginosa.

Abstract: Objectives: To estimate the difference in total serum IgE level between patients with atopic dermatitis (AD) and healthy control subjects and to correlate age and gender of patients, and severity of AD with total serum IgE level. Patients and methods: This is a case-series study on 52 patients with AD, recruited from dermatology clinic at Al-Jumhoori teaching hospital in Mosul, during the first half of 2010. Twenty five healthy non-atopic subjects were recruited from same clinic as a control group. Results: The total serum IgE level in patients with AD was 286.0 (SD 83.1) IU/ml; corresponding value in control group was 47.8 (SD 38.1) IU/ml. Thus, total serum IgE level was significantly higher in patients with AD than in control group (p = 0.007). The highest concentration of total serum IgE level was found among females (p = 0.04), age group 11-15 year (p = 0.09), and severe cases of AD (p = 0.007). Conclusion: Majority of patients with AD have a raised total serum IgE level, which in turn correlates well with female gender, age group 11-15 year, and severity of disease.

Abstract: Objectives: To provide a data base for nutritional assessment indicators among children under five in Al-Hamdaniya district, North of Iraq. Materials and Methods: Study design: A cross sectional study. Study setting: The present study was carried out in 3 primary health care centers. These are: Al-Hamdaniya primary health care center which has a population size in the catchment area of 38310, Bartella primary health care center (41029) and Al-Namrood primary health care center (25466). These centers are located in Al-Hamdaniya district in Nineveh Governorate, North of Iraq which has an overall population of 180980. Study participants: Under five children who were brought to the chosen primary health care centers for vaccination purposes. Outcome measures: Anthropometric measurements (weight and height/length) and WHO growth standard charts were used to compute the nutritional assessment indicators. Age and sex of the examined children were tested as a demographic attributes affect the study indicators. Results: A total of 775 under five children were included in this study; of this sample, 41.4% were less than 6 months old, 53.3% were males. The prevalence of stunting, under weight, wasting, risk of over weight, over weight and obesity were 7.9%, 3.7%, 2.5%, 12.9%, 3.0% and 0.5%, respectively. Stunting is significantly prevalent at age group 24-

Abstract: Background and objectives: Some gastrointestinal and genitourinary tract pathologies can simulate clinical features of acute appendicitis; we aim to determine the alternative diagnosis for the pain in which appendicitis was considered, and to find the incidence of negative appendectomies in our practice. Methods: An observational study, including 558 patients, who underwent an appendectomy at Al Sulaimaniyah Teaching Hospital (STH) from the 2nd of January to the 30th of June 2009. Only patients who underwent urgent appendectomy and the specimen subjected to tissue examination were included. Appendices were labeled acutely inflamed when, macroscopically there were injections of mucosa, fibrinous or purulent film, edematous or necrotic changes of the wall and blood or pus on opening the appendix. Results: Most of the patients were young between 20-40 years age with median age of 22 ±7.7 years. Other pathologies presented in patients with macroscopically normal appendices, included 35 (6.27%) patients had purulent peritoneal fluids occured in young female with tubo-ovarian infections, 12 (2.15%) patients had mesenteric lymphadenitis and 37 (6.63%) patients had rupture Graafian follicles. Histologically normal appendix was present in 178 (31.89 %) patients, 61 (10.93%) of them were males and 117 (20.96%) were females. Conclusion: Normal appendectomies were found in 32 % of the patients, more frequently in young female patients, undergoing early (within 6 hrs since the pain) appendectomy, with the most common alternative diagnosis of tubo-ovarian infections. Keywords: Acute appendicitis, alternative diagnosis, normal appendix.

Abstract: Objective: To study the type of injected agents, clinical features and outcome of conservative treatment of patients with sciatic nerve injury following gluteal intramuscular injection. Methods: A prospective study of patients with sciatic nerve injury following gluteal intramuscular injection from private neurological clinic and neurophysiology unit in Ibn Sena Teaching Hospital in Mosul between January 2008 and July 2010. Results: The total number of the patients was 36. Male patients were 19 and females were 17. There were 28 patients under age of 5 years. Thirty four patients sustained their nerve injury by nurses, and antibiotics were the offending agents in 91.33% of patients. Foot drop is the commonest presenting clinical feature. Complete recovery was reported in 29.6% of the patients, partial recovery in 44.5% and no measurable clinical improvement in 25.5% of them. Conclusion: Children are at higher risk of injury. The injection should be prescribed only when mandatory and administered by a well qualified and competent personnel. Keywords: Intramuscular injection, sciatic nerve, sciatic nerve injury.

Abstract: Objectives: To provide a description of refractive errors in healthy, term-born children, aged 1 through 24 months, and to test the hypothesis that spherical equivalent becomes significantly less hyperopic and less variable with increasing age. Methods: This is a prospective, cross-sectional design, cycloplegic retinoscopy was used to measure the refractive error in both eyes of 100 healthy, term- born children in four age groups. Spherical equivalent, cylindrical power and axis were analyzed as a function of age. Results: Spherical equivalents of right and left eyes did not differ at any age. Hyperopia declined significantly with increasing age. The variability in spherical equivalent also decreased significantly with age. Cylindrical error of one diopter or more was found in 15% of children; the proportion with astigmatism was highest in infancy and then waned. Myopia and anisometropia were rare, occurring in 5% and 2% of the sample, respectively. Conclusions: Significant declines in hyperopia and variability of spherical equivalent appear to be features of emmetropization. The normal prediction limits provide guidelines against which data from individual patients can be compared.

Abstract: Objectives: Routine practice is to examine one histological section for evaluating secondary tumor deposits in the axillary lymph nodes in patients with breast cancer. The aim of the present study is to evaluate whether multiple levels of histological section detect significantly more metastatic deposits in axillary lymph nodes from breast cancer resection specimen than the standard practice of examining one section. Methods: A retrospective study of 30 patients with node negative breast cancer was performed whose specimens were received at AL-Jamhuri Teaching Hospital and private laboratories in Mosul city between the years 2008 and 2010. The original slides and the paraffin wax blocks containing the lymph nodes were retrieved from the archive, and 4 extra levels (separated by 30 µm) were cut from each block and were stained with H & E stain. Results: Of the 30 cases with node negative breast carcinoma, 4 (13.3%) were found to contain extra tumor deposits at deeper levels that were not detected at the original sections. Conclusion: Multiple levels of histological sections separated by relatively small intervals detect more tumor deposits in the axillary lymph nodes than the current practice of examining a single section.

Abstract: Objectives: Painful hip in children is a common pediatric problem and there are several causes for hip pain. In this study we will show the most common causes of hip pain in children and evaluate the procedures performed at our hospital, with a view of establishing which parameters most relevant to make a clinical decision. Methods: This is a case review study which was carried out at Erbil Teaching Hospital between December 2006 and October 2007. Sixty two patients who had con¬sultations and/or been admitted at our hospital complaining of hip pain were included in this study. We did investigations for them and we reviewed their clinical, laboratory and imaging documents. Results: The differential diagnosis was transient synovitis (TS) 54.8%, Legg-Calves-Perthes disease 24.2%, septic arthritis (SA) 8.1%, traumatic synovitis 4.8%, avulsion fractures 3.2 %, brucellosis 1.6%, tuberculosis 1.6%, and non specific synovitis 1.6%. We found that three or more criteria,(the clinical and laboratory parameters), were present in all cases of septic arthritis (100% sensitivity), but also were present in 10% of non septic conditions (90% specificity). Radiographs showed abnormalities in 50% of the cases. Ultrasound showed joint effusion in 43 patients with 100% of sensitivity. Conclusions: Transient synovitis is the most common cause of irritable hip. Application of our scheme might result in a reduction of the number of patients who need hospital admission and also reduction of invasive procedures and containment of the cost. Keywords: Diagnosis of painful hip.

Abstract: Objective: To asses the effects of quetiapine therapy on body mass index (BMI) and serum level of testosterone, prolactin, follicle stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) in newly diagnosed male schizophrenic patients in comparison to healthy controls. Patients and methods: Thirty male patients with schizophrenia were included in this study. The diagnosis of schizophrenia was made according to DSM-IV criteria of the American Psychiatric Association (APA). Another thirty apparently healthy male individuals were included in the study as a control group. Blood samples were taken initially from patients and controls and assay of serum testosterone, prolactin, FSH, LH, and E2 were done using enzyme –linked fluorescent immunoassay (ELFA) technique by vidas instrument. Later, after 6 months of quetiapine therapy, other blood samples were taken and assay of the same parameters were done. Calculation of BMI was done for the patients and controls using special equation. Results: There was an insignificant difference in the mean BMI, serum testosterone, prolactin, FSH, LH, and E2 levels between patients in the pre-therapy stage group and in both the post-therapy stage group and controls. Conclusion: Chronic quetiapine therapy might be regarded as a safe drug with regard to effects on BMI and serum levels of reproductive hormones in newly diagnosed male schizophrenic patients. Keywords: Schizophrenia, quetiapine, BMI, testosterone, prolactin, FSH, LH, E2.

Abstract: Objective: To assess the effect of continuous valproate monotherapy (VPA) on body mass index (BMI), serum leptin, malondialdehyde (MDA) and lipid profile in male epileptic children and adult patients in comparison to healthy male controls. Subjects, materials and methods: A case-control study design was adopted. Samples from 44 male patients (22 less than 18 years old, and 22 over than 18 years old), with primary generalized epilepsy, on continuous VPA monotherapy, for at least six months before participation in the study, were collected over the period from October 2009 to March 2010. Forty-four apparently healthy male volunteers (22 less than 18 years old, and 22 over than 18 years old) without previous history of epilepsy were recruited as controls. Serum levels of leptin, and lipid profile indices were estimated using commercially available kits and a manually prepared reagent for MDA assay. (BMI) was calculated as weight in kilograms divided by the squared height in meters. Results: The results revealed that epileptic children and epileptic adults receiving continuous VPA monotherapy had a significantly higher BMI (p

Abstract: Objectives: 1- To study the frequency of ESBL (extended spectrum beta lactamase) among E. coli clinical isolates. 2- To determine the antibiotic profile for the isolates. 3- To determine the difference between the antimicrobial susceptibility of the ESBL producing E. coli and non producers. Methods: A 4-months review of patients from three different hospitals who were diagnosed to have genitourinary tract infections with E. coli. These isolates were identified and assessed for their production of B-lactamase, and their antibiotic susceptibility to 21 different antimicrobial agents was determined. Results: Out of the total 136 E. coli isolates, 58.82% were found to be ESBL producers. The most effective antimicrobial agent against the isolates was amikacin (85%), followed by ciprofloxacin (67.6%), while all the isolates were fully resistant to penicillin, cephradine, cephalothin and carbencillin. Multi-drug resistance (MDR) were found to be more among the ESBL producers. There was a statistical association between the production of B-lactamase and the resistance to Amikacin, nitrofurantoin, levofloxacin, kanamicin, nalidixic acid, gentamicin, piperacillin, cefotaxime and cephalexin. Conclusions: This study shows that E. coli recovered from clinical specimens produce B-lactamase in high percentage and are resistant to penicillins and most cephalosporins. In addition, the MDR was higher among the B-lactamase producers. Therefore, determination of B-lactamases production, antimicrobial sensitivity of the isolates and strict antibiotic policy should be adopted in hospitals to take steps for reducing the bacterial resistance.

Abstract: Objective: Patients with complicated nocturnal enuresis might show poor response to various forms of treatments, the purpose of this study is to urodynamically assess their bladder function and capacity aiming to predict the underlying cause for their problem and to assess their response to treatment with desmopressin and anticholinergics(oxybutynin). Patients and methods: A retrospective study of 63 patients (50 female and 13 male). Their age ranged between 5-14 years, complaining of complicated nocturnal enuresis. Conducted at the urology clinic in Jordan University Hospital in Amman. All patients underwent urodynamic study, their data were analyzed, and treatment was established accordingly. Response was compared between patients having bladder instability and those with stable bladder, also between those with normal cystometric capacity and those with reduced cystometric capacity. Results: Bladder instability was reported in 55 patients (87.3%) as compared to 8 patients (12.7%) with stable bladder. Also 52 patients (82.5%) had reduced bladder capacity and 11 patients (17.5%) had normal bladder capacity. Of 52 patients with reduced cystometric capacity, 42 patients (80.7%) had partial or no response to treatment. Conclusion: Management of patients with complicated nocturnal enuresis is challenging, and needs an elaborate efforts to settle the cause(s). Bladder instability and reduced bladder capacity represent significant part of the underlying etiologies. The reduced bladder capacity is a reliable predictor of response to treatment with desmopressin and anticholinergics in this group of patients. Keywords: Complicated nocturnal enuresis, urodynamics.

Abstract: A two years old female child with history of a trivial trauma to the lower abdomen was complaining from repeated UTI. Ultrasound and MRI examination of the abdomen and pelvis revealed 48x30 mm solid pelvic mass. Excision of the mass was done through laparotomy. Histopathological examination revealed ovarian cavernous hemangioma.