Background: Fine Needle Aspiration Cytology (FNAC) under image guidance has gained increasing acceptance as the diagnostic procedure of choice for patients with focal hepatic lesions. It can be performed percutaneousl...Background: Fine Needle Aspiration Cytology (FNAC) under image guidance has gained increasing acceptance as the diagnostic procedure of choice for patients with focal hepatic lesions. It can be performed percutaneously or endoscopically. FNA may also be performed at laparoscopy or laparotomy under direct vision when image guided FNA fails to provide diagnostic tissue. In experienced hands, FNA is safe, minimally invasive, accurate, and cost-effective. However, the main aim of this study is to assess the role of FNAC in the evaluation of focal liver lesions. Patients and method: This prospective study was conducted over one year, on 100 patients in Kurdistan Center for Gastroenterology and Hepatology (KCGH) and in Sulaimani General Teaching Hospital. All patients were properly assessed by history analyses and thorough clinical examination. Laboratory investigations including hematological, biochemical, viral markers, and tumor markers were requested. Thus, ultrasonically guided FNA was performed after obtaining a written informed consent from the patients. Results: FNAC showed that eighty patients (80%) had secondary liver metastasis. Ten patients (10%) had HCC;three patients had hemangioma;one patient had abscess;and 6 patients had inconclusive result;two patients had simple cyst. Apart from mild post procedure pain, no complication or mortality had been recorded. Conclusion: FNAC is simple, easy, rapid and a minimally invasive procedure that has an acceptable diagnostic yield for focal liver lesions.展开更多
Iraq is facing water shortage problem despite the presence of the Tigris and Euphrates Rivers. In this research, long rainfall trends up to the year 2099 were studied in Sulaimani city northeast Iraq to give an idea a...Iraq is facing water shortage problem despite the presence of the Tigris and Euphrates Rivers. In this research, long rainfall trends up to the year 2099 were studied in Sulaimani city northeast Iraq to give an idea about future prospects. The medium high （A2） and medium low B2 scenarios have been used for purpose of this study as they are more likely than others scenarios, that beside the fact that no climate modeling canter has performed GCM （global climate model） simulations for more than a few emissions scenarios （HadCM3 has only these two scenarios） otherwise pattern scaling can be used for generating different scenarios which entail a huge uncertainty. The results indicate that the average annual rainfall shows a significant downward trend for both A2 and B2 scenarios. In addition, winter projects increase/decrease in the daily rainfall statistics of wet days, the spring season show very slight drop and no change for both scenarios. However, both summer and autumn shows a significant reduction in maximum rainfall value especially in 2080s while the other statistics remain nearly the same. The extremes events are to decrease slightly in 2080s with highest decrease associated with A2 scenario. This is due to the fact that rainfall under scenario A2 is more significant than under scenario B2. The return period of a certain rainfall will increase in the future when a present storm of 20 year could occur once every 43 year in the 2080s. An increase in the frequency of extreme rainfall depends on several factors such as the return period, season of the year, the period considered as well as the emission scenario used.展开更多
Background: Helicobacter pylori is the most common chronic bacterial infection, and a significant etiological factor in acid peptic diseases and gastric cancer. Dyspepsia is a common gastrointestinal disorder, and the...Background: Helicobacter pylori is the most common chronic bacterial infection, and a significant etiological factor in acid peptic diseases and gastric cancer. Dyspepsia is a common gastrointestinal disorder, and the most common indication for gastroscopy. Detection of H. pylori during endoscopy has become standard clinical practice. Elevated levels of inflammatory markers such as C-reactive protein (CRP), are associated with pathological changes, and hence give useful information for exact diagnosis and therapy. Objectives: To determine the relationship between endoscopic findings, highly sensitive C-reactive protein level (hs-CRP) and H. pylori infection among dyspeptic patients using serological tests, stool antigen for H. pylori and antral histology. Methods: This was a prospective study;patients with dyspepsia, who referred to Kurdistan Teaching Center of Gastroenterology & Hepatology in Sulaimani City were assessed, during the period of December 2012 to March 2014. They underwent gastroscopy, and biopsies were taken from the corpus and antral portions of antral portion for histopathological exam. Patients’ serum samples were tested for H. pylori infection using ELISA method to detect (IgG & IgA) anti-bodies and stool samples were examined using rapid immunoassay method to detect H. pylori antigens. hs-CRP was assessed using ELISA. Results: One hundred dyspeptic patients were included in the study. The mean age was 34.2 years and male comprised 54% of the study samples. The common findings in oesophagogastroduodenoscopy (OGD) examination were antral gastropathy (59%) and duodenal ulcer (21%). A statistically significant (P H. pylori IgG and IgA levels (titer). There was a highly significant (P H. pylori IgG and the endoscopic findings. The highest serum level of H. pylori IgG was found in duodenal ulcer and antral gastritis, (88.86 ± 42.0) and (70.05 ± 35.2) Au/ml, respectively. There was a highly significant correlation (P H. pylori positive antral biopsy, in duodenal ulcer, antral gastritis and duodenitis was 100%, 94.9% and 75% respectively. Also duodenal ulcer and antral gastritis showed high mean and percentage but no significant differences in both H. pylori IgA and stool Antigen.展开更多
Background: Esophageal perforation is a rare, but potentially life threatening injury. The etiology and management of this condition have changed overtime. Iatrogenic causes are increasingly recognized and management ...Background: Esophageal perforation is a rare, but potentially life threatening injury. The etiology and management of this condition have changed overtime. Iatrogenic causes are increasingly recognized and management is evolving towards more conservative approaches. Objective: To review our experience in the management of esophageal perforation in pediatric patients. Patients and methods: This retrospective study was conducted in the Kurdistan center for gastroenterology and hepatology in Sulaimani city. Review of records for cases of esophageal perforation during the period from January 2006 to October 2013 was performed. Results: Ten cases were found to have esophageal perforation. The causes of esophageal perforation were complications of endoscopic dilation for esophageal stricture (n = 7), button battery ingestion (n = 2), complication of esophagoscopy for corrosive injury (n = 1). The mean age was 42 months (range, 18 - 75 months). The diagnosis was made during the procedure in 6 cases, within 12 hours in 2 cases and late in the two cases of battery ingestion. Subcutaneous emphysema and respiratory distress were the main presenting features. The location of perforation was thoracic in 9 cases and cervical in 1 case. Conservative management was successful in 7 patients and surgical closure was done in two patients. One death has been reported. Conclusion: Iatrogenic causes were the most common causes of esophageal perforation. Conservative management with interventions guided by clinical response can have a favorable outcome and may become the best initial treatment strategy in the future. Further larger scale studies are recommended to establish the best protocol for conservative management.展开更多
Background: Endoscopic ultrasonography (EUS) and transadominal ultrasonography (TUS) are two imaging investigations which can be used to assess pancreatobiliary status, although both of these imaging techniques are op...Background: Endoscopic ultrasonography (EUS) and transadominal ultrasonography (TUS) are two imaging investigations which can be used to assess pancreatobiliary status, although both of these imaging techniques are operator and machine dependent, but they have different sensitivity and specificity in detecting pancreatobiliary diseases. Objective: To compare the diagnostic value of EUS versus TUS in the assessment of pancreatobiliary diseases. Patients and Methods: This study was conducted in KCGH (Kurdistan Center for Gastroenterology and Hepatology) in Sulaimani city. Iraqi Kurdistan;the duration of study was 14 months and conducted after approval of Iraqi board ethical committee. One hundred cases were enrolled in the study: 52 of them were females and 48 were males;their ages ranged between 16 - 90 years;informed consent was taken from all patients;all patients underwent proper clinical evaluation;TUS, EUS and Oesophagogastroduodenoscopy (OGD), and in some of them (25 patients) Endoscopic Retrograde Cholangiopancreatography (ERCP), CT scan of abdomen and laboratory investigations were done. Results: EUS detected more cases with common bile duct (CBD) dilatation, CBD stones and pancreatic space occupying lesion (SOL) than TUS, but the differences in the results were not statistically significant. Also EUS detected more cases of intra-abdominal lymph nodes (LNs) and ampullary/peri-ampullary neoplasms than TUS and the differences in the results were statistically significant. Conclusions: Eus is more sensitive than TUS in diagnosing CBD dilatation;it has higher sensitivity than TUS in suspected pancreatobiliary neoplasms;furthermore, EUS can be used for staging and resectability assessment of pancreatobiliary neoplasia.展开更多
Introduction: Common bile duct stone (CBDS) is a common clinical problem that can cause serious complications, such as acute cholangitis and pancreatitis. It is important to have an accurate, safe, and reliable method...Introduction: Common bile duct stone (CBDS) is a common clinical problem that can cause serious complications, such as acute cholangitis and pancreatitis. It is important to have an accurate, safe, and reliable method for the definitive diagnosis of CBDS before proceeding to therapeutic endoscopic retrograde cholangiopancrea-tography (ERCP). Objective: To compare the accuracy of trans-abdominal ultra-sound (TAUS) as a diagnostic tool at our institution—Kurdistan Centre for Gastroen-terology & Hepatology (KCGH)—with invasive tool like ERCP in the diagnosis of bile duct stones, using specificity, sensitivity, and positive and negative predictive values. Patient and Method: After obtaining ethical committee approval & informed consent from every patient. This was a prospective study conducted on 71 patients (24 male patients and 47 females patients) where suspected to have CBDS depending on history, clinical suspicion and blood tests. Their ages range between (2 - 88 years). Both TAUS and ERCP were performed. Final diagnosis was confirmed de-pending on ERCP as it served as a diagnostic standard in diagnosing CBDS. Result: In 71 patients suspected to have CBDS by TAUS, only 46 patients had stone (65%), and 55 patients had stone by ERCP (77%). In our result, sensitivity, specificity, pos-itive predictive value and negative predictive value for TAUS were 80%, 87.5%, 65.5% and 56%, respectively. Conclusion: TAUS can play an important role as an initial screening procedure for CBDS detection because of the various advantages like easy availability, cost effectiveness, no requirement of contrast material and lack of ionizing radiation but should done with other imaging modality to avoid se-rious complication of ERCP.展开更多
文摘Background: Fine Needle Aspiration Cytology (FNAC) under image guidance has gained increasing acceptance as the diagnostic procedure of choice for patients with focal hepatic lesions. It can be performed percutaneously or endoscopically. FNA may also be performed at laparoscopy or laparotomy under direct vision when image guided FNA fails to provide diagnostic tissue. In experienced hands, FNA is safe, minimally invasive, accurate, and cost-effective. However, the main aim of this study is to assess the role of FNAC in the evaluation of focal liver lesions. Patients and method: This prospective study was conducted over one year, on 100 patients in Kurdistan Center for Gastroenterology and Hepatology (KCGH) and in Sulaimani General Teaching Hospital. All patients were properly assessed by history analyses and thorough clinical examination. Laboratory investigations including hematological, biochemical, viral markers, and tumor markers were requested. Thus, ultrasonically guided FNA was performed after obtaining a written informed consent from the patients. Results: FNAC showed that eighty patients (80%) had secondary liver metastasis. Ten patients (10%) had HCC;three patients had hemangioma;one patient had abscess;and 6 patients had inconclusive result;two patients had simple cyst. Apart from mild post procedure pain, no complication or mortality had been recorded. Conclusion: FNAC is simple, easy, rapid and a minimally invasive procedure that has an acceptable diagnostic yield for focal liver lesions.
文摘Iraq is facing water shortage problem despite the presence of the Tigris and Euphrates Rivers. In this research, long rainfall trends up to the year 2099 were studied in Sulaimani city northeast Iraq to give an idea about future prospects. The medium high （A2） and medium low B2 scenarios have been used for purpose of this study as they are more likely than others scenarios, that beside the fact that no climate modeling canter has performed GCM （global climate model） simulations for more than a few emissions scenarios （HadCM3 has only these two scenarios） otherwise pattern scaling can be used for generating different scenarios which entail a huge uncertainty. The results indicate that the average annual rainfall shows a significant downward trend for both A2 and B2 scenarios. In addition, winter projects increase/decrease in the daily rainfall statistics of wet days, the spring season show very slight drop and no change for both scenarios. However, both summer and autumn shows a significant reduction in maximum rainfall value especially in 2080s while the other statistics remain nearly the same. The extremes events are to decrease slightly in 2080s with highest decrease associated with A2 scenario. This is due to the fact that rainfall under scenario A2 is more significant than under scenario B2. The return period of a certain rainfall will increase in the future when a present storm of 20 year could occur once every 43 year in the 2080s. An increase in the frequency of extreme rainfall depends on several factors such as the return period, season of the year, the period considered as well as the emission scenario used.
文摘Background: Helicobacter pylori is the most common chronic bacterial infection, and a significant etiological factor in acid peptic diseases and gastric cancer. Dyspepsia is a common gastrointestinal disorder, and the most common indication for gastroscopy. Detection of H. pylori during endoscopy has become standard clinical practice. Elevated levels of inflammatory markers such as C-reactive protein (CRP), are associated with pathological changes, and hence give useful information for exact diagnosis and therapy. Objectives: To determine the relationship between endoscopic findings, highly sensitive C-reactive protein level (hs-CRP) and H. pylori infection among dyspeptic patients using serological tests, stool antigen for H. pylori and antral histology. Methods: This was a prospective study;patients with dyspepsia, who referred to Kurdistan Teaching Center of Gastroenterology & Hepatology in Sulaimani City were assessed, during the period of December 2012 to March 2014. They underwent gastroscopy, and biopsies were taken from the corpus and antral portions of antral portion for histopathological exam. Patients’ serum samples were tested for H. pylori infection using ELISA method to detect (IgG & IgA) anti-bodies and stool samples were examined using rapid immunoassay method to detect H. pylori antigens. hs-CRP was assessed using ELISA. Results: One hundred dyspeptic patients were included in the study. The mean age was 34.2 years and male comprised 54% of the study samples. The common findings in oesophagogastroduodenoscopy (OGD) examination were antral gastropathy (59%) and duodenal ulcer (21%). A statistically significant (P H. pylori IgG and IgA levels (titer). There was a highly significant (P H. pylori IgG and the endoscopic findings. The highest serum level of H. pylori IgG was found in duodenal ulcer and antral gastritis, (88.86 ± 42.0) and (70.05 ± 35.2) Au/ml, respectively. There was a highly significant correlation (P H. pylori positive antral biopsy, in duodenal ulcer, antral gastritis and duodenitis was 100%, 94.9% and 75% respectively. Also duodenal ulcer and antral gastritis showed high mean and percentage but no significant differences in both H. pylori IgA and stool Antigen.
文摘Background: Esophageal perforation is a rare, but potentially life threatening injury. The etiology and management of this condition have changed overtime. Iatrogenic causes are increasingly recognized and management is evolving towards more conservative approaches. Objective: To review our experience in the management of esophageal perforation in pediatric patients. Patients and methods: This retrospective study was conducted in the Kurdistan center for gastroenterology and hepatology in Sulaimani city. Review of records for cases of esophageal perforation during the period from January 2006 to October 2013 was performed. Results: Ten cases were found to have esophageal perforation. The causes of esophageal perforation were complications of endoscopic dilation for esophageal stricture (n = 7), button battery ingestion (n = 2), complication of esophagoscopy for corrosive injury (n = 1). The mean age was 42 months (range, 18 - 75 months). The diagnosis was made during the procedure in 6 cases, within 12 hours in 2 cases and late in the two cases of battery ingestion. Subcutaneous emphysema and respiratory distress were the main presenting features. The location of perforation was thoracic in 9 cases and cervical in 1 case. Conservative management was successful in 7 patients and surgical closure was done in two patients. One death has been reported. Conclusion: Iatrogenic causes were the most common causes of esophageal perforation. Conservative management with interventions guided by clinical response can have a favorable outcome and may become the best initial treatment strategy in the future. Further larger scale studies are recommended to establish the best protocol for conservative management.
文摘Background: Endoscopic ultrasonography (EUS) and transadominal ultrasonography (TUS) are two imaging investigations which can be used to assess pancreatobiliary status, although both of these imaging techniques are operator and machine dependent, but they have different sensitivity and specificity in detecting pancreatobiliary diseases. Objective: To compare the diagnostic value of EUS versus TUS in the assessment of pancreatobiliary diseases. Patients and Methods: This study was conducted in KCGH (Kurdistan Center for Gastroenterology and Hepatology) in Sulaimani city. Iraqi Kurdistan;the duration of study was 14 months and conducted after approval of Iraqi board ethical committee. One hundred cases were enrolled in the study: 52 of them were females and 48 were males;their ages ranged between 16 - 90 years;informed consent was taken from all patients;all patients underwent proper clinical evaluation;TUS, EUS and Oesophagogastroduodenoscopy (OGD), and in some of them (25 patients) Endoscopic Retrograde Cholangiopancreatography (ERCP), CT scan of abdomen and laboratory investigations were done. Results: EUS detected more cases with common bile duct (CBD) dilatation, CBD stones and pancreatic space occupying lesion (SOL) than TUS, but the differences in the results were not statistically significant. Also EUS detected more cases of intra-abdominal lymph nodes (LNs) and ampullary/peri-ampullary neoplasms than TUS and the differences in the results were statistically significant. Conclusions: Eus is more sensitive than TUS in diagnosing CBD dilatation;it has higher sensitivity than TUS in suspected pancreatobiliary neoplasms;furthermore, EUS can be used for staging and resectability assessment of pancreatobiliary neoplasia.
文摘Introduction: Common bile duct stone (CBDS) is a common clinical problem that can cause serious complications, such as acute cholangitis and pancreatitis. It is important to have an accurate, safe, and reliable method for the definitive diagnosis of CBDS before proceeding to therapeutic endoscopic retrograde cholangiopancrea-tography (ERCP). Objective: To compare the accuracy of trans-abdominal ultra-sound (TAUS) as a diagnostic tool at our institution—Kurdistan Centre for Gastroen-terology & Hepatology (KCGH)—with invasive tool like ERCP in the diagnosis of bile duct stones, using specificity, sensitivity, and positive and negative predictive values. Patient and Method: After obtaining ethical committee approval & informed consent from every patient. This was a prospective study conducted on 71 patients (24 male patients and 47 females patients) where suspected to have CBDS depending on history, clinical suspicion and blood tests. Their ages range between (2 - 88 years). Both TAUS and ERCP were performed. Final diagnosis was confirmed de-pending on ERCP as it served as a diagnostic standard in diagnosing CBDS. Result: In 71 patients suspected to have CBDS by TAUS, only 46 patients had stone (65%), and 55 patients had stone by ERCP (77%). In our result, sensitivity, specificity, pos-itive predictive value and negative predictive value for TAUS were 80%, 87.5%, 65.5% and 56%, respectively. Conclusion: TAUS can play an important role as an initial screening procedure for CBDS detection because of the various advantages like easy availability, cost effectiveness, no requirement of contrast material and lack of ionizing radiation but should done with other imaging modality to avoid se-rious complication of ERCP.
