Background and objective: Pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormones. Pancreatitis is a condition characterized by inflammation of the pancreas. When the digestive enzymes are activated before they are released into the small intestine, they begin attacking the pancreas, and pancreatic damage happens. This study aimed to evaluate the association between pancreatic lipase, gamma-glutamyl transferase, and acute pancreatitis in patients living in Erbil city. Methods: The present study was carried out at the College of Medicine, Hawler Medical University from December 2017 to July 2018. A total of 35 patients with acute pancreatitis and 25 healthy controls were investigated. Examinations of serum pancreatic lipase and gamma glutamyl transferase were carried out spectrophotometrically for both groups using commercial diagnostics kits. Results: The results showed that the mean level of serum pancreatic lipase in patients with pancreatitis was significantly higher (P <0.01)compared to normal healthy control. The mean serum gamma glutamyl transferase was higher in patients with acute pancreatitis when compared to the reference group but not statistically significant. Conclusion: In the frame of this work, we delineate that pancreatic diseases had a significant effect on pancreatic enzymes reflected by a significant increase in serum lipase, whereas the level of gamma glutamyl transferase increased marginally. Keywords: Pancreatitis; Pancreatic lipoprotein lipase; Gamma glutamyl transferase.

Introduction Right iliac fossa (RIF) pain in young women remains a diagnostic challenge. It is one of the commonest surgical emergency presentations, however a sub-group of patients have no definitive diagnosis. Current tools used includes observations, routine investigations, ultrasound, and laparoscopy. Specific recommendations for a better management of this cohort are required. Method Retrospective multi-centre (two different cultural backgrounds) analysis of females aged 17 to 35 acutely admitted with RIF pain over a five-month period was conducted. The length of stay, current tools used for investigation (including laparoscopy) and cost were calculated. Pregnant women and those with a definitive picture of appendicitis were excluded. Results A total of 154 patients with RIF pain were studied. 77 (50%) were sent home within 24 hours. Of the remaining 77 patients, 21 laparoscopies were performed, 10 had positive findings (47.6%), 9 appendicitis and 1 carcinoid tumour. Only two CT scans were performed, both indicated positive cases that required surgery. Patients without a definitive diagnosis had an average hospital stay of 4 days compared to 2 when successfully managed conservatively. Cost calculated for negative laparoscopy was £2915 and £469 for CT scan combined with one-day stay. Conclusion This study demonstrated that a sub-group of young females with RIF pain would benefit from early CT scan, to definitively diagnose or rule out appendicitis. This would be more cost effective and help to avoid un-necessary invasive procedure and prolonged hospital stays. Guidelines are needed for more timely diagnosis and optimization of management in this cohort.

No abstract

Background and objective: The most common cancer of women worldwide is breast cancer and usually presents as a breast lump. Fine needle aspiration cytology and ultrasonography are two investigational techniques used to differentiate malignant breast lump from benign one. This study aimed to find out and compare the specificity, sensitivity, and predictive values of ultrasonography versus fine needle aspiration cytology for the diagnosis of malignant breast lump. Methods: Patients who presented with clinically palpable breast lump at the department of Surgery, Rizgary Teaching Hospital, Erbil, from October 2014 to March 2016, were included. The age of the study participants ranged from 15 to 56 years. The highest rate (28.9%) was among the age group 35-45 years. Breast abscess, cystic breast lumps, and recurrent lumps have been excluded. The ultrasonographic evaluation was done by using 7.5 MHz probe for all patients at the department of radiology and fine needle aspiration cytology at the department of histopathology. All the patients underwent excision of the lumps, and histopathological examination was done for tissues. Specificity, sensitivity, and predictive values of ultrasonography and fine needle aspiration cytology were estimated, taking the histopathological result as the gold standard. A comparison of values was made. Results: Ninety patients with 93 breast lumps were included in this study. Fine needle aspiration cytology reported 28 lumps as malignant lumps and 63 as benign, and two cases were indeterminate. Ultrasonography reported 27 cases as malignant, 54 as benign, and nine as indeterminate, while three breast lumps were failed to be detected. Sensitivity, specificity, positive and negative predictive values of ultrasonography and fine needle aspiration cytology in diagnosing malignant breast lump were 94.74%, 100%, 100%, 97.22%, and 90.48%, 100%, 100%, 95.24%,respectively. Conclusion: Ultrasonography and fine needle aspiration cytology are 100% specific in diagnosing malignant breast lesions. Although ultrasonography appears more sensitive than fine needle aspiration cytology, it has a higher percentage of the indeterminate report. Keywords: Fine needle aspiration cytology; Ultrasonography; Breast lumps.

Background: Breast cancer has a tremendous heterogeneity in its clinical behavior. The objective of this study is to assess the positive expression of estrogen receptors (ER), progesterone receptors (PR) and HER2 overexpression in relationship to the age of patients, and certain prognostic parameters such as tumor grade, size and lymph node involvement. Patients and methods: A cross sectional case study was conducted between June 2011 and June 2014 at the pathology department of Rizgary General Hospital, Erbil, Iraq. 114 Confirmed cases of breast cancer were studied. Immunohistochemistry was used to evaluate the expression of ER, PR and HER2 status. Patients' mean age was 48±5 (Range: 28-83) years; 57% of them were ≤50 years. Results: The expression of ER and PR was 58.8% and 49.1% respectively. HER2 overexpression (score +3) was 29.8%. Hormone receptors (ER and PR) correlated significantly with age and grade of the tumor whereas HER2 overexpression correlated significantly with grade and lymph node involvement. An inverse correlation was observed between the distribution of both ER & PR and overexpression of HER2. Conclusions: Expression of hormone receptors were evident in about half while HER2 overexpression was observed in less than one third of patients in our population. Different and common correlations were observed between ER, PR and HER2 expression and other patient and tumor characteristics. HER2 overexpression is associated with an aggressive form of breast cancer with high histological grade and negative ER status.