Adult intussusception : A 14-year retrospective study of clinical assessment and computed tomography diagnosis.

BACKGROUND AND STUDY AIMS: Intussusception in adults often remains unrecognized. Our aim was to report our experience with this entity to determine the usefulness of CT scan in its preoperative diagnosis. PATIENTS AND METHODS: The medical records and imaging studies of all patients ≥16 years of age with intussusception, who were managed at our hospitals, were retrospectively reviewed. RESULTS: 17 cases of adult intussusception (7 males, 10 females; mean age 35.9 years; age range of 16-78) were identified. The diagnosis was possible in all patients using CT scan. The underlying etiologies were colon cancer (n=2), lymphoma (n=2), small bowel polyps (n=2), jejunal lipoma (n=1), metastatic melanoma (n=1), Meckel's diverticulum (MD) (n=1) and idiopathic (n=1). In the remaining 7 patients, the intussusceptions were of the transitory form and were treated conservatively and no significant sequela occurred after a follow-up of 2-60 months. CT scan findings in transient cases characteristically showed that the intussusception was localized to the proximal intestine and all of them had a short segment (2-4 cm) of intussusception. CONCLUSIONS: The important role of the CT in the preoperative diagnosis of intussusception and characterizing its causes cannot be overemphasized. All transient cases had a short segment of intussusception.

Assessment of genotoxicity of vincristine, vinblastine and vinorelbine in human cultured lymphocytes: a comparative study.

Vincristine (VCR), vinblastine (VBL) and vinorelbine (VRL) are anticancer agents from the Vinca alkaloid family that have the potential to induce genotoxic effect. The aim of the present study was to compare the genotoxic effect of VCR, VBL and VRL. Levels of 8-hydroxy-2-deoxy guanosine (8-OHdG) and sister chromatid exchanges (SCEs) were measured in cultured human blood lymphocytes treated with VCR, VBL and VRL at concentrations of 0.01 and 0.1 µg/mL. Results showed that VCR, VBL and VRL significantly increased the 8-OHdG levels (p <0.05), whereas it did not cause a significant increase in the frequencies of SCEs in human blood lymphocytes as compared to controls. On the other hand, all three agents significantly increased cells mitotic index (p <0.05). At both tested concentrations, the magnitude of the increase in 8-OHdG was VBL>VCR>VRL. In conclusion, VCR, VBL and VRL induce DNA damage as indicated by the increase in the 8-OHdG biomarker but with different magnitude.

Meats, milk and fat consumption in colorectal cancer.

BACKGROUND: Data from several studies suggest that a diet high in meat, including processed meat and fat, may have an association with the development of colorectal cancer (CRC). METHODS: The present study aimed to investigate the relationship between meats, dairy products, fat consumption and the risk of CRC in Jordanians. A case-control study was performed at the five largest hospitals in Jordan. Dietary data were collected from 220 diagnosed cases of CRC and 281 healthy disease-free controls. The CRC cases were matched as closely as possible to controls using age, sex, occupation and marital status. RESULTS: The consumption of different levels and frequencies of several food types, including meats, chicken, milk and fish, was found to be associated with the risk of developing CRC. Added fats and oils were inversely associated with CRC risk with odds ratio = 0.33 (95% confidence interval = 0.13-0.83, Ptrend = 0.005). The predominant fat added by cases and controls was olive oil, followed by corn oil. CONCLUSIONS: The results of the study suggest that the consumption of some types of meat, processed meats and Labaneh (strained yogurt) may be associated with the risk of developing CRC.

Primary hydatid cyst of the pancreas.

BACKGROUND: Hydatid cyst of the pancreas is rare, accounting for less than 1% of the various sites of hydatid disease, even in countries where echinococcosis is endemic. We report a case of pancreatic hydatid cyst to increase awareness for this important condition. CASE REPORT: We describe a 33-year-old male with abdominal discomfort of one-year duration. On abdominal examination, there was mild tenderness with fullness in the right upper quadrant. Laboratory investigations revealed no abnormalities. Abdominal ultrasonography showed a cystic mass over the head of the pancreas. Abdominal CT scan confirmed the presence of a solitary cyst in the pancreatic head, with no enhancement on contrast CT. Indirect hemagglutination test for hydatid disease was negative. A pre-operative diagnosis of cystic neoplasm of the pancreas was made and laparotomy was done; on exploration there was a cystic mass arising from the head of the pancreas. A pericystectomy was carried out and the diagnosis of hydatid cyst of the pancreas was confirmed by histopathology. The postoperative period was uneventful and no recurrence was seen after 2 years of follow-up. CONCLUSION: Pancreatic hydatidosis, though very rare, should be considered in the differential diagnosis of pancreatic cystic lesions in the appropriate epidaemiological setting.

Overview of extremity arterial trauma in Jordan.

AIM: The objectives of this study were to review etiologies of trauma, associated injuries, diagnosis, management, and outcomes of patients with vascular injuries in the extremities and relate factors in their treatment to the outcome of the injured extremity. METHODS: Data were collected retrospectively on 73 patients diagnosed to have upper and lower limbs arterial injuries at King Abdullah University Hospital, Jordan, between 2001 and 2006. Factors evaluated included demographic data, location of vessels injured, mechanism of injury, associated injuries, treatment, and outcome. RESULTS: Patients were predominantly males (54 patients). Isolated vascular trauma was present in 36 patients, while in the remaining 37 patients vascular trauma was aggravated by concomitant injuries. The most common etiology of vascular injuries in the upper and lower extremities was a penetrating injury found in 38 patients (52%). The vessels most commonly involved were the femoral and brachial arteries. Various associated injuries were identified mainly orthopedic in 21 patients (29%) and nerve injuries in 18 patients (25%). Autogenous vein graft interposition was mostly performed in 32 patients (44%). Permanent disability was seen in 8 patients (11%), limb amputation was performed in 5 patients (7%). Five patients died due to associated intraabdominal, thoracic, and head injuries giving a mortality rate of 7%. CONCLUSIONS: Delay in surgery, blunt trauma and extensive soft tissue defect in combined orthopedic and vascular injuries were associated with increased risk of amputation, while associated nerve injuries and bone injuries with extensive soft tissue damage are risk factors of poor quality outcome.

Adrenal cavernous haemangioma.

The adrenal gland is a rare location for haemangioma. Approximately 52 surgical cases have been reported in the literature. We report a huge non-functioning adrenal haemangioma presenting in a 50-year-old woman with flank pain. This was illustrated by computed tomography. It was surgically removed and diagnosed postoperatively as adrenal haemangioma. Although rare, adrenal haemangioma should be included in the differential diagnosis of adrenal neoplasms. The risks of haemorrhage, necrosis and thrombosis impose in the majority of cases surgical excision, particularly in tumours more than 3 cm in diameter.

Primary gastric lymphoma in Jordan with special emphasis on descriptive epidemiology.

The aim of this study was to examine the clinicopathological features and epidemiology of primary gastric lymphoma in Jordan as a model for Middle East countries where such data is scarce. From 1991--2002, 219 patients with primary gastric malignancy were managed at our hospitals. Among these there were 19 patients with primary gastric lymphoma. Pertinent data for these patients were analyzed. Primary gastric lymphoma constituted 65.5% of all gastrointestinal lymphoma and 8.7% of all gastric malignancies. Male-to-female ratio was 2.8:1. The mean age was 56 years (range 39--82). The incidence was 0.6/100,000. The proximal third was the most common localisation. Abdominal pain was the commonest presentation. Low-grade MALT lymphomas, high-grade MALT lymphomas, diffuse large cell B lymphomas and T cell lymphoma were found in 21.1, 26.3, 47.4 and 5.3%, respectively. Nine patients had gastrectomy followed by chemotherapy, 6 patients had palliative resection, 3 patients had chemotherapy only and the remaining patient was treated with Helicobacter pylori eradication. The mean follow-up for all patients was 42.2 months. The 5-year survival rates for stages IE (n=5), IIE (n=4), IIIE (n=6) and IVE (n=4) were 100, 67, 27 and 0%, respectively (p=0.0003). The overall 5 years survival was 48.2%. Primary gastric lymphoma in Jordan shares some epidemiological features with western disease. Jordanian patients are detected and treated after a relatively long delay. Advanced stage at diagnosis correlated with poor outcome. There is a need of an earlier diagnosis and subsequent better care.

Tuberculous mastitis: a disease not to be forgotten.

OBJECTIVE: To present our experience with tuberculous mastitis to increase the awareness of surgeons, pathologists and radiologists about this rare disease. PATIENTS AND METHODS: Records of nine patients with tuberculous mastitis were retrospectively reviewed. RESULTS: Tuberculous mastitis was seen in 0.6% of our patients with surgically treated mammary disease. There were eight females (mean age 32.9 years) and one male. All female patients were parous, two were lactating and one was pregnant. A unilateral breast mass mimicking breast cancer and breast abscess were the presenting feature in seven and two patients, respectively. Two patients had previous pulmonary tuberculosis. Radiological findings were not specific. Fine needle aspiration was performed for seven patients, and excisional biopsy for all patients. The final diagnosis was based on demonstration of acid-fast bacilli in biopsy specimens in two patients, and histopathology aided by polymerase chain reaction in the remaining seven patients. Mastectomy was performed for one patient due to severe breast destruction. All patients had satisfactory results on antituberculosis treatment. CONCLUSION: Tuberculous mastitis is a rare entity in patients with mammary disease. A high index of suspicion is the cornerstone for diagnosis. Conservative surgery and anti-tuberculosis drugs seem to be adequate treatment.

Faecal incontinence in patients with anal fissure: a consequence of internal sphincterotomy or a feature of the condition?

BACKGROUND AND OBJECTIVE: The function of the internal sphincter is disturbed in patients with chronic anal fissure due to persistent hypertonia and it may lead to a certain degree of incontinence. Our aim is to assess the results of lateral internal sphincterotomy and to identify any degree of incontinence related to the disease. METHODS: This prospective study included a review of all patients operated upon by the authors who performed division of the internal sphincter at or below the upper limit of the fissure. A questionnaire was completed by each patient before surgery and then after surgery with regard to any degree of incontinence such as soiling of underclothes, control of flatus and accidental bowel motion. RESULTS: 126 patients with chronic anal fissure were studied. The male to female ratio was 0.8:1. Minor degrees of incontinence were present prior to surgery in 35 patients (28%) and in 31 (25%) patients after surgery, the majority of them were incontinent before surgery. CONCLUSION: Based on the results of this study, minor degrees of incontinence could be a symptom of chronic anal fissure and not the sequelae of lateral internal sphincterotomy.

Prevalence of Helicobacter pylori in Northern Jordan. Endoscopy based study.

OBJECTIVE: Helicobacter pylori infection is considered the most common infection worldwide and is associated with many other disorders. The aim of this study is to determine the prevalence of this infection among patients undergoing endoscopy in Northern Jordan. METHODS: Between November 1998 and September 2000, all patients referred from the Gastro-esophageal Clinic to the Endoscopy Unit at Princess Basma Teaching Hospital, Irbid, Northern Jordan were enrolled in this prospective study. For each patient clinical and epidemiological data was collected and endoscopy was performed. At least 3 antral biopsies were obtained from each patient, and these were examined histologically for the presence of gastritis and stained for Helicobacter pylori using modified Giemsa stain. RESULTS: A total of 197 consecutive patients (113 females) with a mean age of 40.2 years (range 15-91 years) were studied. Abdominal pain was the highest presenting symptom. Gastritis 91% and esophagitis 42% were the most frequent endoscopic findings. Gastritis was documented histologically in 183 (93%) of patients. Helicobacter pylori was found in 161 patients (82%), with all of these having histological gastritis. The 11 patients with gastric ulcer, compared to the 51 out of the 59 (86%) patients with duodenal ulcer, showed Helicobacter pylori in their biopsies. CONCLUSION: The prevalence of Helicobacter pylori infection in patients subjected to an upper gastrointestinal endoscopy in Jordan is high. This study confirms that Helicobacter pylori is significantly associated with gastritis and peptic ulcer. Further studies are needed to determine the types of Helicobacter pylori strains present in Jordan.