Hydatid Liver Disease: Long Term Results of a Surgical Management

To review the experience of the surgical management of liver hydatid cystic disease between 1973 and 1999. We retrospectively analyzed the files of 169 patients with liver hydatid cyst that were managed surgically between 1973 and 1999 with emphasis on the surgical treatment and its results. There were 112 females and 57 males with a mean age of 39.2 +/- 17.9 years [range: 5-85 years]. Most patients were symptomatic, 29.5% presented with abdominal pain, 27% with jaundice or gave a history of jaundice and 6% with weight loss. Hepatomegaly and palpable abdominal mass were the commonest physical signs. The right liver was affected more than the left 68% and 21.8%, respectively. In 13.6%, the cysts were >/= 10 cm in diameter. Pre-operative complications were common in our series [37.8%] and the commonest preoperative complication was intra-biliary rupture [34%]. The surgical procedures performed were variable, external drainage and omentoplasty were the commonest procedures performed. The mortality, morbidity and recurrence rates were high, 6.5%, 53.8% and 7%, respectively. The surgical management of liver hydatid disease is still carrying a high morbidity, mortality and recurrence rates, radical surgery when feasible, is associated with better results regarding length of hospital stay, morbidity and mortality than conservative surgery. The best surgical procedure to be employed is yet to be determined. The surgical option should be tailored to the case and according to the surgeon's experience and setup

New trends in the clinicopathological features of differentiated thyroid cancer in Central Jordan

To investigate the current trends in presentation and distribution of differentiated thyroid cancer [DTC] at the largest referral hospital for endocrine cancers in Central Jordan. We analyzed the clinical features, management and outcome of 110 patients diagnosed with thyroid carcinoma at Jordan University Hospital, Amman, between 1996 and 2001. Papillary carcinoma was diagnosed in 87 patients [80%], follicular carcinoma in 3 patients [2.7%], Hurthle cell carcinoma in 8 patients [7.3%], medullary carcinoma in 5 [4.5%], and anaplastic carcinoma in 4 patients [3.6%], metastatic cancer in 2 patients and lymphoma in one patient. Time course analysis showed an increasing trend in surgery for thyroid cancer from 28 cases in 1986-1991 to 48 in 1996-2001. As time advanced, the incidence of locally invasive disease and lymph node involvement markedly increased over the last 5 years of the study [from 28-62%]. All patients with follicular carcinoma were diagnosed in the period 1986-1994. After thyroidectomy and a follow up period of 2-15 years, 10 patients died of their disease, 4 of these died within one year from anaplastic thyroid carcinoma. The dramatic decline in the incidence of follicular thyroid carcinoma combined with the increase in the advanced forms of thyroid cancer in Central Jordan may suggest a possible environmental factor in thyroid carcinogenesis in this region. We suggest a larger scale studies and steps to investigate the etiologic factors for thyroid carcinogenesis in Central Jordan

Clinical spectrum of primary hyperparathyroidism

Primary hyperparathyroidism [1HPT] is now being diagnosed with increasing frequency. Simultaneously there has been an apparent change in the presentation of the disease and indications for surgery. The aim of this study was to examine the clinical presentation, indications for surgery, and outcomes of neck explorations for primary hyperparathyroidism. This study was carried out over a 12 year period, January 1990 to April 2002 at Jordan University Hospital, Amman, Jordan. Information on the indications, procedure performed, pathology and complications of all neck explorations for 1HPT was obtained from a retrospective thyroid/parathyroid surgical database. A minimum of 12 months follow-up was required in order to determine outcome of surgery. Out of 40 patients diagnosed with primary hyperparathyroidism at Jordan University Hospital, Amman, over 12 years, 14 patients [35%] diagnosed 4 years after the onset of their disease. Severe bone disease was the main indication for surgery in 28 patients; 5 patients with fractured bones, 2 patients with bone cysts, 3 patients with brown tumors and severe osteoporosis and backache in 22 patients; renal calculi in 10 patients; muscle ache and weakness in 14 patients; acute pancreatitis in one patient and asymptomatic HPT following biochemical screening in one patient. Two patients continued to have persistent hypercalcemia after the first operation; one of them has been cured by reoperation for an ectopic parathyroid in the anterior mediastinum resulting in an overall cure rate of 97.5%. This study showed that severe bone disease with fractures, bone cysts and brown tumors are still the most common presentation of primary hyperparathyroidism in Jordan; this is most likely due to delay in diagnosis and initiation of treatment. It is important to screen for hyperparathyroidism in high risk patients and to refer these patients to specialized centers for proper management

Computed tomography in the localization of parathyroid glands in primary hyperparathyroidism

Twenty three patients with a diagnosis of primary hyperparathyroidism [PHP] were treated at Jordan University Hospital [JUH] between June 1984 and June 1990. After establishing the diagnosis of PHP clinically and biochemically, localization of the diseased gland [s] was attempted by computerized tomography [CT] in 15 patients. CT findings were later correlated with the surgical and pathological results. In 10 patients, the surgical and pathological findings corresponded to those reported by CT. Identification of parathyroid tumours on CT scan was made retrospectively in three patients. In two other patients the diseased glands did not correspond to the CT findings. The accuracy of CT localization in this study is 66.6% prospectively and 86.6% retrospectively

Thyroglossal duct cysts at Jordan University Hospital

This report discusses thirty three patients with thyroglossal duct cysts treated at Jordan University Hospital. Their ages ranged from 9 months to 47 years and the sex ratio was 2/1 in favour of males. All patients had a neck swelling, six had a chronic sinus and three presented with acute inflammation. Thirty one patients underwent surgery. Sistrunk operation was performed in 21 patients with one recurrence. Simple excision of the cyst was performed in 10 patients and was followed by recurrence in four. The recurrent cases were successfully treated by Sistrunk operation

Carcinoma of the thyroid gland: report of 100 cases from Jordan University Hospital

This is a study of 100 cases of thyroid cancer treated at Jordan University Hospital, between 1975 and 1989. It included 84 cases of differentiated carcinoma, 8 cases of medullary thyroid carcinoma [MTC], 7 cases of anaplastic carcinoma and a case of lymphoma. The sex ratio was 2.2/1 in favor of females. The peak age incidence for the differentiated and medullary tumors was between the fourth and fifth decades, and for the anaplastic carcinomas in the seventh decade. Clinical diagnosis of malignancy was possible in 35% of cases only. In the remaining 65%, it presented as a solitary nodule [45%], as a multinodular goiter [MNG] [13%], as cervical lymph node metastasis with occult thyroid cancer [6%], and as a toxic goiter [1%]. Lymph node metastases were detected at presentation in 24% of patients and distant metastases were only met in about 7% of patients. The prognosis of patients with medullary and anaplastic carcinomas was very poor. On the other hand the prognosis of those with differentiated thyroid cancers depended largely on age at presentation. Only 3.8% of patients less than 50 years old died of their thyroid in contrast to 48% of those above 50 years old

Experience with pheochromocytoma at Jordan University Hospital

This report presents nine patients with pheochromocytoma treated at Jordan University Hospital [JUH] between 1977 and 1988. The presentation was variable; seven patients were hypertensive and two were normotensive and presented with pain and a mass in the abdomen. One patient presented while undergoing surgery and was successfully diagnosed and resuscitated. One patient had adrenal medullary hyperplasia and eight patients had nine tumours. The accepted criteria of malignancy were not documented but two tumours might have been malignant due to the presence of adhesions, one of them had local recurrence two years after primary surgery, the other died post operatively. No patient had a positive family history or evidence of MEN type 2 syndrome but three had associated neoplasms including neurofibromatosis, uterine fibroids and cholangiocarcinoma

Phytobezoars of the whole gastrointestinal tract: report of case and revive of the literature

A phytobezoar is a bulky mass of ingested fruit or vegetable fibres occurring in the stomach or intestine. It can cause gastric or intestinal obstruction. Intestinal obstruction caused by food is still an interesting subject. This report is about a schizophrenic patient who had a divine call to eat very large amounts of dried beans and seeds which caused acute intestinal obstruction of the whole gastrointestinal tract. The literature on the subject of phytobezoar has been reviewed

Pre-sacral tumours in adults: report of three cases and review of the literature

Pre-sacral tumours are uncommonly encountered in adults. Three patients with benign sacral tumours presented to Jordan University Hospital: one with a discharging buttock sinus, one after having an obstructed labour and the third one with continuous anal pain. Their diagnosis was unduly delayed for lack of consideration of the disease entity. All had previous attempts of surgical excision which had failed. All three patients had benign tumours, two teratomas and one neurofibroma. All had total excision of their pre-sacral tumours through a posterior trans-sacral approach with no ano-rectal dysfunction. One patient developed wound haemorrhage which was controlled by wound packing. The three patients are free of recurrence seven years, three years and six months after surgical excision. The incidence, clinicopathological presentation, diagnosis and management of presacral tumours have been reviewed