Polymorphisms in NOS3, ACE and PAI-1 genes and risk of spontaneous recurrent miscarriage in the Gaza Strip

This study was conducted to investigate the correlation between spontaneous recurrent miscarriage [RM] and common polymorphisms in angiotensin-converting enzyme [ACE], plasminogen activator inhibitor 1 [PAI-1] and endothelium-derived nitric oxide synthase 3 [NOS3] genes among women experiencing RM in the Gaza Strip. The presence of these genetic profiles was determined for 100 women who had had at least 3 constitutive abortions and 100 controls without any history of abortion using molecular biological techniques. The ACE D/D polymorphism was present in 49% of the study population and in 54% of the controls [p = 0.479]. Similarly, there was no significant difference detected in the distribution of polymorphisms for PAI-1, with the 4G/4G genotype present in the study group and in controls [p = 1.00]. NOS3 4a/4a was present in 4% of the study group and in none of the 100 controls [p = 0.123]. In this study, we also discovered a new variant in the NOS3 gene which was named 4c allele and was encountered in 1 patient and in 1 control subject. There was no significant association between ACEI/D, PAI-1 4G/5G and NOS3 4a/4b and the occurrence of first-trimester RM. In-depth investigation of the association of NOS3 4a/4a with RM is strongly recommended

magnetic resonance image findings of idiopathic granulomatous mastitis

Idiopathic granulomatous mastitis is a rare disease of the breast. Clinically and radiologically it may mimic breast carcinoma. We report a case of a 34-year-old female patient with this diagnosis, concentrating on magnetic resonance image MRI findings and its clinical application. There have been other reports on MRI findings in this entity in the radiological literature, but in our case report, clinical, cytological, pathological, and radiological correlations are also provided

Male breast disorders in Jordan. Disease patterns and management problems

To highlight the features and management problems of male breast disorders in an eastern country such as Jordan. Data regarding 33 male patients who underwent surgery for breast diseases in the Department of Surgery at Jordan University of Science and Technology, Irbid, Jordan, between the year 1996 and 2002 were analyzed. Gynecomastia [45.5%], ductal carcinoma [18.2%], and lipoma [12.1%] were the most frequent lesions. Endocrine testing when the clinical diagnosis was physiologic gynecomastia was not yielding. Many features of male breast carcinoma in Jordan [symptomatology, male to female ratio, high education rate, age, diagnostic yield of fine-needle aspiration, histological type, and estrogen receptor status] did not depart from the experience of others. Delayed presentation is evident from the fact that 57% of tumors were stage III. Loco-regional control was achieved by modified radical mastectomy. Tamoxifen was used in 5 patients, and chemotherapy in 4 patients. The patient with stage I is still disease free 6 years after the diagnosis. The 5-year survival rate for stages II and III was zero. Rare lesions [cystic hygroma, cystic mastopathy, fibroadenoma, duct papilloma, tuberculosis, periductal mastitis, and the previously unreported primary primitive neuroectodermal tumor of the breast] accounted for the rest of the group. The patient with primary primitive neuroectodermal tumor of right breast was treated by mastectomy and adjuvant chemotherapy. He remains disease free 31 months after the diagnosis. Unawareness and the fact that male breast enlargement is considered a social stigmata are responsible for the delayed presentation. The value of fine needle aspiration cytology and mammography is not widely appreciated. The wide spectrum of potential pathologies calls for referring all patients to specialized breast units

clinical and epidemiological features of hydatid disease in Northern Jordan

To elaborate on the epidemiology of hydatid disease in Jordan as a model for the Middle East, and highlight the obstacles that face disease control in the region. The clinical and epidemiological data for 65 patients with the diagnosis of hydatid cyst [who were treated in the Department of Surgery, Jordan University of Science and Technology, Irbid and its affiliated hospitals, between January 1994 through to September 2003] were analyzed. Fifty-five patients were interviewed for details of life style. Forty-six% of patients were below 40- years of age. Fifty-seven% were females. All interviewed patients gave history of contact with dogs and history of ingestion of raw vegetable food. The latter in addition to a high zoonotic infection rate and uncontrolled animal movement were factors contributing to the high prevalence. Optimization of control programs in the Middle East requires the establishment of a regional center. Wide traveling has made it essential for physicians practicing in non-endemic areas to be aware of the diverse presentations of this disease when dealing with immigrants from endemic areas

Colorectal cancer in young patients under 40 years of age Comparison with old patients in a well defined Jordanian population

To determine the incidence of colorectal cancer [CRC] in young Jordanians and to compare the clinical and pathological characteristics with those in older patients and with those in high risk populations. Clinical and pathological data of all the patients with CRC managed at Princess Basma Teaching Hospital, Irbid, Jordan over a 10 year period [January 1990 through December 1999] were recorded. The patients were divided according to age into group one [those <40 years] and group 2 [> 40 years]. The 2 groups were compared regarding sex, predisposing conditions, tumor stage at presentation, tumor differentiation, mucin secretion, tumor invasion, presentation with complications and tumor location. The data were compared with those of "high risk" Western populations and with the few reports coming from "low risk" populations, mainly from Kingdom of Saudi Arabia and Egypt. Out of 202 patients evaluated, 4 were excluded. Group1 constituted 20.2% of the patients, 17.5% of them have predisposing conditions. Comparison between group 1 and 2 revealed the following: female sex [65% versus 50.6%, p=0.104], advanced stages at presentation [65% versus 41%, p=0.005], rectal tumors [50% versus 39.2%] and right side tumors [15% versus 29.1%] [p=0.18]. Mucinous and signet ring tumors [30% versus 15.8%, p=0.04], poor tumor differentiation [20% versus 18.3%, p=0.78] and presentation with complications [21% versus 22.2%, p=0.96]. The incidence of CRC in young Jordanians was much higher than high risk populations. Half of the tumors were rectal. Young patients have more advanced stage and more mucin secreting tumors. The relative high frequency and frequency of predisposing conditions calls for family screening and surveillance in the presence of predisposing conditions

Torsion of abdominal appendages presenting with acute abdominal pain

Diseases of the abdominal appendages are rare causes of abdominal pain in all age groups. Patients and Nine patients with torsion and infarction of abdominal appendages were retrospectively reviewed. Four patients had torsion and infarction of the appendices epiploicae, four patients had torsion and infarction of part of the greater omentum, and one patient had torsion and infarction of the falciform ligament. The patient with the falciform ligament disease represents the first reported case of primary torsion and infarction of the falciform ligament, and the patient with the transverse colon epiploica represents the first reported case of vibration-induced appendix epiploica torsion and infarction. The patient with the falciform ligament disease presented with a tender upper abdominal mass, and the remaining patients were operated upon with the preoperative diagnosis of acute appendicitis. The presence of normal appendix with free serosanguinous fluid in the peritoneal cavity should raise the possibility of a disease, and calls for further evaluation of the intra-abdominal organs. If the diagnosis is suspected preoperatively, CT scan and ultrasound may lead to a correct diagnosis and possibly conservative management. Laparoscopy is playing an increasing diagnostic and therapeutic role in such situations

Breast cancer in the north of Jordan with special emphasis on descriptive epidemiology

To study the epidemiology of breast cancer in Jordan [as a model for Middle East countries] and compare it with western figures. This may clarify the effect of environmental factors on the incidence, age distribution, and to a lesser extent the etiology of breast cancer. One hundred and nineteen female patients treated for breast cancer at Princess Basma Teaching Hospital between 1992 and 1997 were reviewed retrospectively regarding pertinent epidemiological and clinical features. Incidence was 11/100,000/year. Mean age at presentation was 49 years. In the population as a whole the mean age at first birth was 22.3 years. Stages III and IV constituted 34% of the cases. The ratio of axillary nodal involvement was 60%. The mean duration of symptoms was 8.3 months. In Jordan [like other Middle East countries] breast cancer is rare, affecting women at a remarkably young age. This is mostly a reflection of the high percentage of young people in these communities. This high portion of young people may also explain the low incidence since the incidence of breast cancer is known to increase with age. Tendency toward having the first child at a young age, Arabian dietary habits with a high vitamin C and B-carotene content, and to a lesser extent abstinence from alcohol and smoking are other factors which may be responsible for reducing breast cancer risk in the area. The percentage of late breast cancer is high, reflecting the need for active screening and education programs

Inversion of the normal appendix druging the course of abdominal surgery: a procedure not to be forgotten

A retrospective study, assessing the safety and feasibility of inverting the normal appendix during the course of abdominal surgery. Between early 1989 and early 1999 and during the course of open abdominal surgery 108 patients underwent total inversion of their normal looking appendix [74 cholecystectomies, 19 peptic ulcer operations, 12 splenectomies, 2 external hernias, one hydatid liver disease] and recently 2 laparoscopic inversions of the appendix were performed during the course of laparoscopic cholecystectomy. Inversion was easy and added 5-10 minutes to the operation time during open surgery cases. Early in the series there were three conversions to formal appendectomy because of fibrosis of the appendix in patients over 40 years of age, which led us to restrict inversion to patients under 40 years and with no fibrosis. There were 2 wound infections in cholecystectomy patients [2/74=2.7%] and 1 wound infection in peptic ulcer patients [1/19=5.3%]. During the same period 306 patients underwent open cholecystectomy without appendicular inversion and of these 9 developed wound infection [9/306=2.9%]. In 20 patients who underwent peptic ulcer surgery without appendicular inversion there was one case of wound infection [1/20=5%]. Following the introduction of laparoscopic cholecystectomy in September 1995 2 patients underwent laparoscopic inversion of the appendix during laparoscopic cholecystectomy without any postoperative complications. Total inversion of the appendix during the course of open abdominal surgery is a safe and useful adjuvant, obviates the risk of opening the intestine of formal appendectomy and eliminates the risk of future appendicitis which is significant especially in splenectomised patients. Laparoscopic inversion may have a place, but it needs further evaluation