Studies have shown the safety and effectiveness of laparoscopic cholecystectomy (LC) for acute cholecystitis (AC). Our aim was to establish the outcome of LC in patients with AC on the basis of duration of the attack before surgery took place, the type of gallbladder inflammation, and patient sex.All 204 patients at Princess Basma Teaching Hospital who underwent LC for AC by the authors between September 1994 and June 1999, were retrospectively reviewed. They were categorized into Group I, where surgery took place within 72 hours of the acute attack (N = 78; 54 women and 24 men), and Group II, if later than that (N = 126; 70 women and 56 men). Gallbladder pathology was classified as gangrenous, empyema, edematous, mucocele, or AC along with contracted fibrosed gallbladder.Conversion to open cholecystectomy was needed in 12% of the total series. In Group I, 3.8% of the patients needed conversion compared with 16.7% in Group II patients (P = 0.01). Also, 4% of the female patients needed conversion compared with 24% of the male patients (P = 0.000). There was an association between the pathological type of AC and the likelihood of conversion (P = 0.002), conversion being least common in those with mucocele and most common in those with empyema and gangrene. The median operation time was 75 +/- 36 minutes, but the operation time for Group II patients was significantly longer (P = 0.001) than in Group I patients. Operation time in the male patients was significantly longer than in the female patients (P = 0.000). There was no statistically significant difference in the duration of hospital stay in the two groups or in men and women. There were no deaths or main bile duct injuries in the series. In successful LC, missed stones occurred in 3.3% of the patients. Bile collection, which was treated by open surgery, developed in one female patient.Laparoscopic cholecystectomy is a reliable and safe modality for the management of AC. It was not associated with an increased incidence of bile duct injury in this series. It should be the first choice before resorting to open surgery. Factors associated with increased conversion include delay in surgery of more than 3 days from the acute attack and certain pathology, with conversion being more likely in empyema. Conversion also was more likely in male patients.
To investigate the expression of p21 and p27 factors in gallbladder cancer (GBC), and to correlate their expression with clinicopathological parameters: age, gender, stage, invasion, and grade.Thirty-two surgically resected specimens were collected between 1994-2001 from different health centers in north Jordan. Tissues belong to 25 females and 7 males were examined immunohistochemically. The study took place in the Pathology Department, Jordan University of Science and Technology, Jordan.Levels of p21 were found in 75% and p27 in 25%. Furthermore, p21 was expressed in 50% of the specimens which are belong to patients with ages <64 years, whereas all specimens for ages >64 years have p21WAF1/CIP1 expression (p=0.001). The expression of p21 between advanced stages (stages III and IV) was 89.5% and early stages (stages I and II) was 53.8 % (p=0.031).The p27 expression was markedly decreased in GBC cases (25%) and there were no significant correlation between p27KIP1 expression and all clinicopathological parameters including gender, World Health Organization grades, stages, and invasion, whereas the expression of p21 was 75% and there was a significant correlation between p21 and the clinicopathological parameters including gender, stages, and invasion.
Anatomy is considered the core of surgery. Surgeons often complain about deficiencies in their junior doctor's level of knowledge in anatomy. The study aim was to compare opinions of final year medical students and consultant surgeons regarding current methods of teaching anatomy and which methods should be utilized to enhance medical student's anatomy knowledge. Two questionnaires were developed: one for consultant surgeons and the other one was for medical students. These questionnaires surveyed consultant surgeons and senior medical students regarding their views on various aspects of undergraduate anatomy teaching including: increasing time for anatomy teaching, anatomy knowledge level, surgeons participation in teaching, best methods of teaching and examination of anatomy, areas of strength and weakness among students, and adequacy of current teaching to understand radiology images, laparoscopic and endoscopic views. The response rate for consultants and students was 62.6 %. Surgeons who encouraged increasing the time for undergraduate anatomy teaching were 77.1 %. A significant percentage of surgeons and students thought that their junior surgeons / student level of anatomical knowledge was poor (63.4 % and 46.6 % respectively). Additionally, over two thirds of surgeons and students thought that surgeons participation in anatomy teaching in the first 3 years in medical schools may be useful (68.0 % and 69.0 % respectively). Cadaveric teaching was selected as best method of anatomy teaching by 81.0 % surgeons and 79.6 % students. Only 33.1 % surgeons and 35.4 % student thought that our current anatomy teaching was adequate to understand radiologic, laparoscopic and endoscopic views. Surgeons and students were in agreement regarding students' reduced levels of anatomy knowledge. One particular aspect of such deprivation was students' inability to interpret radiological pictures, laparoscopic and endoscopic views. Increasing time dedicated for anatomy teaching, involving surgeons in the process of anatomy teaching and redirecting the focus on cadaveric dissection may be beneficial.
Objectives: To study the various options of revascularization, mainly the role of Percutaneous Transluminal Angioplasty (PTA) in the treatment of Critical Limb Ischemia (CLI) and to assess the clinical outcome.
Material and Methods: A retrospective study was performed involving 109 consecutive patients (75 men and 34 women; mean age 59 years, range 45-87). Fifty-nine patients were diabetic, and sixty-four smokers. Balloon angioplasty for critical limb ischemia was performed in 78 limbs, while Percutaneous Transluminal Angioplasty (PTA) and/or surgery in 34 limbs. Immediate and at one year outcome was examined by case note review to determine survival, amputation-free survival, and limb salvage.
Results: In the angioplasty, technical success was achieved in 66 (84%) out of 78 limbs, while in the combined PTA and/or surgery it was 22 limbs (65%) out of 34 limbs. The overall amputation rate was 22%. The follow-up period was 12 months. The overall in-hospital mortality was five patients (4.6%). Eighty patients (74%) had their feet spared from major amputation as a result of revascularization. Only sixty-tow patients were available for follow-up which revealed that 84% of them were doing well 12 months after their revascularizations. Patients with an initially successful angioplasty had a good outcome.
Conclusions: The results of this study justify the use of PTA as a first-line treatment for critical limb ischemia; technical failure does not preclude conventional surgery. CLI is highly prevalent among diabetes. CLI was significantly associated with diabetes, smoking, and gangrene. Educational programs and aggressive approach are highly needed to reduce the risk of amputations
To determine the risk factors for the development of esophageal adenocarcinoma in these patients with columnar-lined esophagus (CLE).Data collected retrospectively on 597 consecutive patients diagnosed at endoscopy and histology to have CLE at Leeds General Infirmary between 1984 and 1995 were analyzed. Factors evaluated included age, sex, length of columnar segment, smoking, and drinking habits, history of non-steroidal ingestion, presence of endoscopic esophagitis, ulceration or benign strictures and presence of Helicobacter pylori in esophageal biopsies. Univariate and multivariate analyses were performed to identify risk factors for the development of adenocarcinoma.Forty-four patients presented or developed esophageal adenocarcinoma during follow-up. Independent risk factors for the development of adenocarcinoma in patients with CLE were males (OR 5.12, 95%CI 2.04-12.84, P=0.0005), and benign esophageal stricture (OR 4.37, 95%CI 2.02-9.45, P=0.0002). Male subjects and patients who developed benign esophageal stricture constituted 86% (n=38) of all patients who presented or developed esophageal adenocarcinoma. The presence of esophagitis was associated with a significant reduction in the development of esophageal carcinoma (OR 0.28, 95%CI 0.13-0.57, P=0.0006). No other clinical characteristics differentiate between the non-malignant and malignant group.In patients with CLE, endoscopic surveillance for the early detection of adenocarcinoma may be restricted to male subjects, as well as patients who develop benign esophageal strictures.
Dietary components that promote inflammation of the colon have been suggested to be risk factors in the development of colorectal cancer (CRC). The possible link between inflammatory potential of diet and CRC has been investigated in several developed or Western countries. Despite the fact that dietary choices in the Middle East differ markedly from those in the West, results have not been reported from any study conducted in a Middle-Eastern population. We examined the association between dietary inflammatory index (DII) scores and CRC in a case-control study conducted in Jordan. This study included 153 histopathologically confirmed CRC cases and 202 disease-free control subjects' frequency matched on age, sex, and occupation. Data were collected between January 2010 and December 2012, using interviewer-administered questionnaires. DII scores were computed from dietary data reported using a food frequency questionnaire. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age, sex, education, physical activity, body mass index, smoking, and family history of CRC. Subjects with higher DII scores were at increased odds of CRC, with the DII being used both as a continuous variable (ORcontinuous = 1.45, 95% CI: 1.13-1.85; 1-unit increase corresponding to ≈20% of its range in the current study) and as a categorical variable (ORtertile 3 vs tertile 1 = 2.13, 95%CI: 1.23-3.72). Our results, based on a Jordanian population, add to the growing literature indicating that a pro-inflammatory diet is associated with increased odds of CRC.
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.
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