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Introduction While appendicitis is considered one of most common acute surgical conditions, several studies have reported abnormal histopathological findings in appendectomy specimens; however, sending all appendices to histopathology is not yet routinely done.Here we report many unusual findings. Those unusual findings played a role not only in confirming acute appendicitis as a cause of the presentation in some cases but also discovering etiologies that mimic it with great impact on its management. Methods Between January 2011 and December 2017, a total of 1510 patients were operated with appendectomy for a primary diagnosis of acute appendicitis. Among them, a total of 72 patients had incidental histopathologic findings in association with acute appendicitis or other pathologies instead of acute appendicitis. A retrospective analysis for those 72 patients was performed with all data being retrieved from the electronic health record system. Results Patients ages ranged between 4 and 71 years with a mean age equal to 23.1 years (SD = 14.2). Majority of patients were women (n = 52; 72.2%). Sixty of the seventy-two cases were seen in patients with negative appendectomies (n = 333) with an overall rate of 18% among this group of patients. The remaining 12 patients had additional findings in histopathology specimens beside acute appendicitis (n = 1131) with an overall rate of 1%. The most commonly reported pathologies were serositis, ovarian cysts, and Enterobius vermicularis in descending frequency. Conclusion Identification of unusual histopathological findings during microscopic examination of resected appendices is more common in female patients and in patients with negative appendectomy. histopathologic assessment of specimens will allow detection of congenital, infectious or malignant pathologies that mimic acute appendicitis clinically even in the absence appendicitis microscopically., Highlights • Appendicitis is a global disease, and one of the most common major general surgical emergencies. • Identification of unusual histopathological findings is more common in female patients and in patients with negative appendectomy. • Appendicitis can be secondary to different bacterial, viral, parasitic and malignant pathologies. • critical histopathologic assessment of resected appendicies is mandatory to exclude secondary rare pathologies.

Hashemite University, a pioneering higher education institution in Jordan, has established the first academic nursery for children in Jordan. The nursery has a dual purpose, as it offers quality ch...

Gastric cancer (GC) and pancreatic cancer (PC) are the third and seventh most likely cancers to cause death worldwide. We aimed to determine the dietary and lifestyle factors of patients with GC or PC and their associated risk among Jordanians. This case-control study enrolled 587 adults (patients with PC, 101; patients with GC, 172; healthy controls, 314) between March 2015 and August 2018, who were assessed using interview-based personal and physical activity questionnaires. Multivariable logistic regression models were taken as measures for predictors of GC and PC risk. We showed that GC and PC patients had higher pre-diagnosis body-mass indexes, a greater proportion smoked and had a family history of cancer than controls. Furthermore, consumption of two snacks [odds ratios (OR)=0.44, 95% confidence intervals (CI): 0.23∼0.85], three snacks (OR=0.04, 95% CI: 0.01∼0.23) and no meals eaten outside (OR=0.31, 95% CI: 0.09∼0.99) showed a protective effect against GC, and consumption of three snacks (OR=0.08, 95% CI: 0.02∼0.40) reduced significantly the risk of PC. These results suggest that bodyweight, physical activity, smoking, and family history of cancer are among factors that affect GC and PC risk among Jordanians.

The purpose of this study is to identify Medical Leadership Competences among medical students at Hashemite University, and analyze the significant differences in the university participants based ...

SUMMARY: 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.

Cystic echinococcosis (CE)/hydatidosis is a zoonotic disease which occur in human and herbivore animals as a result of infection with the larval stage of the taeniid cestode Echinococcus granulosus sensu lato (s. l.). In human, CE is a serious public health concern in many parts of the world including Jordan. The present review will cover CE causative agent: E. granulosus species/genotypes; life cycle of E. granulosus parasite, all published previous studies on CE in Jordan (humans, intermediate hosts, definitive host) as well as its diagnostic methods in human.

Summary Background & aimsDietary pattern and lifestyle have been reported to be important risk factors in the development of colorectal cancer (CRC). However, the mechanism of action of dietary factors in CRC disease is unclear. The aim of this study is the examination of several dietary choices and their potential association with the risk of developing CRC. MethodsDietary data was collected from 220 subjects who were previously diagnosed with CRC, and 281 control subjects (matched by age, gender, occupation and marital status). The data was collected between January 2010 and December 2012, using interview-based questionnaires. Multivariate logistic regression was used to estimate the relationship between dietary choices and risk of developing colorectal cancer. ResultsFactor analysis revealed three major dietary patterns. The first pattern we identified as the “Healthy Pattern”, the second was identified as “High Sugar/High Tea Pattern” and the third as “Western Pattern”. In the Healthy Pattern group we found a 10.54% variation in food intake, while the intake variation was 11.64% in the Western Pattern. After adjusting for confounding factors, the Western Pattern food choice was found to be significantly associated with an increased risk of developing CRC (OR = 1.88; 95% CI = 1.12–3.16). The results for the Healthy and High-Sugar/High Tea Patterns showed a decrease, but the statistic was not significant for the risk of CRC development. ConclusionThe Western Pattern of dietary choice was directly associated with CRC. The association between the dietary food choice in the Healthy and High-Sugar/High Tea Patterns and colorectal cancer needs further study in our Jordanian population. Jordan Higher counsel of education

SUMMARY: Anatomy it is one of the basic sciences in medical schools where it takes part in the first 3 years of the teaching curriculum. Aim of this survey is to explore the perception of medical students in undergraduate level to anatomy teaching in different medical schools and identify the weakness points and area which could help in improvement the teaching process with better outcomes. This is a prospective multi center study, conducted between May 2018 to August 2018 on 313 medical students in their internship year and 6th year of medical school. Questionnaire was sent to students taking into consideration the importance of protecting the students privacy. The questionnaire was developed after thorough review of the literature and its items were chosen following consultation with senior medical colleagues and educationalists . The questionnaire was created using 8-item liker scale so as to enforce an answer and avoid neutral answer. Out of 313 students: 212 were female students (67.7 %) and 101 (32.3 %) were males. 123 students (39.3 %) favored the combination of cadaveric dissection and multimedia as best teaching methods. Most students thought that the classic methods of teaching may not be very helpful in understanding the radiological images and laparoscopic intra-operative views. Most students suggested that engaging surgeons in anatomy teaching may improve their clinical knowledge in Anatomy. Our results showed that the approach of teaching could be improved by including combination of multiple techniques specially cadaveric dissection and multimedia sessions. The results also encouraged medical schools to utilize surgeons more often to teach anatomy.

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 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.

Background: The effects of consuming fast foods, sweets and beverages on the development of colorectal cancer (CRC) are unclear. The aim of this case-control study was to assess possible associations between the consumption of different fast foods, sweets and beverages and CRC risk in a Jordanian population. Methods: Two hundred and twenty diagnosed CRC cases and 281 controls were enrolled. Diet history was obtained using a validated quantitative questionnaire. Results: Consumption of some types of fast food, and particularly falafel, was associated with an increased risk of developing CRC. Elevated risk was found for potato and corn chips with an AOR of 4.36 (95%CI: 1.24-15.28) for daily consumption and 3.33 (95%CI: 1.00-11.11) for ≥5 servings/week. Consuming 1-2 or >5 servings per week of fried potatoes or 2-3 servings per week of chicken in sandwiches also increased the risk while exposure to fresh tomato juice and hot pepper sauce on a monthly basis appeared to exert a protective effect. Conclusions: Consumption of fried fast food items was significantly linked with an increased risk of developing CRC in Jordan.

A case-control study was conducted to evaluate some parameters of antioxidant and nutritional status in patients with colorectal cancer (CRC) and healthy controls. The present study was based on 25 patients with diagnosed CRC, ranging in age from 35 to 76 years with the mean age of 51.3±11.3 years. There were healthy volunteers (age-and sex-matched) serving as the control subjects. We measured reduced glutathione (GSH, a marker of antioxidant response) in erythrocytes along with the examination of plasma antioxidants (vitamin E, A and beta-carotene) and vitamin D. The results showed that the levels of vitamin D and GSH in the blood of the patients with CRC were significantly lower than the control. However, there was no significant difference in the level of vitamin A and beta-carotene in the blood of the patients with CRC as compared to control group. Interestingly, our results showed a significant increase in the blood level of Vitamin E in patients with CRC as compared to control. Our results indicate significant role of oxidativeinduced injury in the CRC carcinogenesis. The decreased concentrations of vitamin D and GSH in CRC cases as compared to controls could be used as predictors for having CRC. However, no association between vitamin A and beta-carotene and CRC was detected. Higher plasma concentration of vitamin E was noticed in CRC cases comparing to controls.

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.

The aim of this study was to examine the validity and reliability of a food frequency questionnaire (FFQ) among a convenience sample of healthy adults in Jordan. A modified version of the questionnaire known as Diet History Questionnaire I, which measures dietary intakes over a 1-year period, was administrated to 101 apparently healthy men and women recruited from three large medical centers in Jordan. Fifty-five participants completed the modified FFQ and three 24-hour recalls. Participants (N=101) completed the FFQ two times separated by a 1-month period. Reliability of the FFQ was assessed using test–retest method. Mean age of participants was 33.4±18.5 years. Energy, carbohydrate, fiber, fat, saturated fat, calcium, and iron had deattenuated correlations of .732, .563, .544, .487, .484, .451, and .459, respectively. The FFQ and 24-hour recalls produced similar agreement percentages ranging between 25.5% and 43.6%. Mean energy-adjusted reliability coefficients ranged from .695 to .943. A Cronbach's α for the total FFQ items of .857 was found. The modified FFQ has reasonable relative validity and reliability for energy, carbohydrate, fiber, fat, saturated fat, calcium, and iron intakes in Jordanian adults over a 1-year period. However, its application may require additional modifications and validation efforts. Future research is warranted to further modify and test the FFQ in a larger and more diverse sample of Jordanians as well as to develop FFQ for the use among other age groups.

Natural flora are considered a major source of new agents for the treatment of Helicobactor pylori. The plants used in this study were selected based on previous traditional use.In this study, we evaluated the effect of extracts of 16 medicinal plants grown in Jordan against clinical isolates of H. pylori.Tested plant extracts included Aloysia triphylla (L'Her.) Britton (Verbenaceae), Anethum graveolens L. (Apiaceae), Artemisia inculata Delile (Asteraceae), Capparis spinosa L. (Capparaceae), Crataegus aronia (L.) Bosc ex. DC. (Rosaceae), Inula viscose (L.) Ait (Asteraceae), Lavandula officinalis Chaix. (Lamiaceae), Lepidium sativum L. (Cruciferae), Origanum syriaca L. (Lamiaceae), Paronychia argentea Lam. (Caryophyllaceae), Passiflora incarnate L. (Passifloraceae), Psidium guajava L. (Myrtaceae), Sarcopoterium spinosum (L.) Spach (Rosaceae), Sesamum indicum L. (Pedaliaceae), Urtica urens L. (Urticaceae) and Varthemia iphionoids Boiss (Asteraceae). Clinical isolates of H. pylori were tested in vitro for susceptibility to each of the above plant crude extracts using disk diffusion method, and the MIC value was determined for each plant extract using the serial dilution method.Results showed that ethanol extracts of most medicinal plants exerted cytotoxiciy against H. pylori isolates. Among the tested plant extracts, A. triphylla (MIC: 90 µg/mL, MBC: 125 µg/mL) and I. viscosa (MIC: 83 µg/mL, MBC: 104 µg/mL) showed the strongest activity against both isolates of H. pylori.Jordanian medicinal plants might be valuable sources of starting materials for the synthesis of new antibacterial agents against H. pylori.

There can be few medical conditions that have been surrounded by as much confusion about their definition or terminology as columnar-lined esophagus (CLE); approximately 30 different terms and eponyms have been used to describe this condition. The history of this condition can be divided into five stages: (i) descriptive stage, 1906-1950; (ii) "argument" stage, 1950-1963; (iii) "significant" stage, 1963-1973; (iv) surveillance stage, 1973-1990; and (v) refined research stage, 1990-present. The use of the eponym "Barrett's" to describe CLE is not justified from a historical point of view. Lining of the lower esophagus by columnar epithelium was termed "Barrett's esophagus" after the presentation by Barrett in 1957. Although this finding has been attributed to Barrett, the work of others, including Tileston, Lortat-Jacob, and Allison and Johnstone, preceded Barrett's description. The historical aspects of CLE were reviewed to show how little Norman Barrett had contributed to the core concept of this condition in comparison to the contributions of other investigators, particularly the contribution of Philip Allison. Based on many discussed historical facts, we are not in favor of retaining the term "Barrett's esophagus" and we propose that CLE be henceforth referred to as "columnar-lined esophagus".

Objectives Postcatheterization femoral artery pseudoaneurysm is a troublesome complication following percutaneous canulations of the femoral artery. Both diagnostic and therapeutic options in the management of these pseudoaneurysms have changed dramatically, with surgery being required only rarely. We aimed to perform a comprehensive review of our experience, techniques and results in treating postcatheterization femoral artery pseudoaneurysms. Methods A retrospective study of all patients presenting with local complications following invasive percutaneous femoral artery canulations over a five-year period was performed. Physical examination with color Doppler ultrasound analysis identified 29 femoral artery pseudoaneurysms. Surgery, duplex-guided compression, and thrombin injection were the main therapeutic options. Results Fourteen cases of femoral artery pseudoaneurysms were treated by duplex-guided compression obliteration with a 78.5% success rate. Four patients had spontaneous thrombosis of their pseudoaneurysms. Five patients underwent percutaneous thrombin injection. Six patients had conventional surgery. Three cases failed duplex-guided compression: one closed with thrombin injection, and two were repaired surgically. Follow-up US showed no recurrent pseudoaneurysms for patients who underwent successful duplex-guided compression. Conclusion Despite the voluminous data in the literature of treating postcatheterization femoral artery pseudoaneurysms by thrombin guided injection, as a quick and effective method of therapy, with infrequent failures and complications, our study confirms the clinical usefulness of duplex-guided compression in the management of these pseudoaneurysms. The possibility of spontaneous thrombosis of small pseudoaneurysms is emphasized.

It has been noted that following a laparoscopic cholecystectomy (LC), liver function parameters were disturbed. The causes of this disturbance are still controversial.The serum levels of eight parameters of liver function were measured both before and 24 hours after surgery in 142 consecutive patients who underwent LC, 23 patients who underwent open cholecystectomy (OC), and in 25 patients who underwent a conventional hernial repair. The same anesthetic protocol was applied to all patients in the various groups and in the case of LC; the intra-abdominal pressure was maintained at 12 mmHg of CO2.Twenty-four (24) hours after surgery, there was a statistically significant change of all the eight parameters studied, except alkaline phosphatase in patients who underwent LC, whereas there were only 3 patients from the OC group who had changes of alanine aminotransferase and aspartite aminotransferase and 2 patients who had raised levels of direct bilirubin, and no changes were observed among those who had conventional hernial repair. We found that 83% of the patients showed more than a 100% increase in at least one parameter, 43% showed an increase in two or more parameters, and 23% showed an increase in three or more parameters. We also observed a significant drop of total proteins and albumin levels in all patients who had LC.It appears that the pneumoperitoneum plays a major role in these changes. Although these changes of liver function were of no clinical relevance in healthy patients, the safety of the procedure must nonetheless be assessed in those with underlying liver diseases.

The role of diet in colorectal cancer (CRC) in Jordan has not been studied previously. This study aimed at examining the association between food groups (including grains, fruits, vegetables, milk, and meat and legumes) and CRC risk in Jordan. We compared intakes of the different food groups among CRC patients (n=167) and matched controls (n=240) by age, sex, occupation, and marital status. A validated food frequency questionnaire was used to collect dietary data. Logistic regression was used to evaluate the association of quartiles of intakes of the different food groups with CRC risk. In addition, the association of selected food items with CRC risk was examined. Odds ratios (ORs) for the fourth versus the first quartile of intake were 2.92 [95% confidence interval (CI): 1.40-6.08] for grains, 1.66 (95% CI: 0.81-3.40) for vegetables, 0.55 (95% CI: 0.26-1.16) for fruits, 0.96 (95% CI: 0.46-1.97) for milk, and 1.43 (95% CI: 0.68-2.98) for meat and legumes. In a comparison of the highest with the lowest weekly frequency of consumption, there was a direct association between the risk of CRC and the frequency of consumption of chicken (OR=2.52, 95% CI: 1.33-4.77). An increase in risk was observed with increased consumption of white bread (OR=3.13, 95% CI: 1.18-9.25), whereas consumption of whole bread was associated with a decreased risk for CRC (OR=0.32, 95% CI: 0.12-0.84). Our results support a role of diet in CRC. Direct associations were found for grains, white bread, and chicken, whereas an inverse relation was reported for whole bread. Higher Council of Science and Technology

Objective: Diet and lifestyle have been reported to be important risk factors for the development of colorectal cancer (CRC). However, the association between total energy and nutrient intake and the risk of developing CRC has not been clearly explained. The aim of our study is to examine the relationship between total energy intake and other nutrients and the development of CRC in the Jordanian population. Research Methods and Procedures: Dietary data was collected from 169 subjects who were previously diagnosed with CRC, and 248 control subjects (matched by age, gender, occupation and marital status). These control subjects were healthy and disease free. Data was collected between January 2010 and December 2012, using interview-based questionnaires. Logistic regression was used to evaluate the association between quartiles of total energy, macro- and micronutrient intakes with the risk of developing CRC in our study population. Results: Total energy intake was associated with a higher risk of developing CRC (OR = 2.60 for the highest versus lowest quartile of intake, 95% CI: 1.21–5.56, p-trend = 0.03). Intakes of protein (OR = 3.62, 95% CI: 1.63–8.05, p-trend = 0.002), carbohydrates (OR = 1.41, 95% CI: 0.67–2.99, p-trend = 0.043), and percentage of energy from fat (OR = 2.10, 95% CI: 0.38–11.70, p-trend = 0.009) significantly increased the risk for the development of CRC. Saturated fat, dietary cholesterol and sodium intake showed a significant association with the risk of developing CRC (OR = 5.23, 95% CI: 2.33–11.76, OR = 2.48, 95% CI: 1.18–5.21, and OR = 3.42, 95% CI: 1.59–7.38, respectively), while vitamin E and caffeine intake were indicative of a protective effect against the development of CRC, OR = 0.002 (95% CI: 0.0003–0.011) and 0.023 (95%CI: 0.008–0.067), respectively. Conclusion: Our results suggest an increased risk for the development of CRC in subjects with high dietary intake of energy, protein, saturated fat, cholesterol, and sodium, and diets high in vitamin E and caffeine were suggestive of a protective effect against the risk of developing CRC. Impact: This is the first study in Jordan to suggest that it may be possible to reduce CRC risk by adjusting the intake of some macro-and micronutrients.

ObjectiveTo determine if combined subfascial (SF) and subcutaneous (SC) bupivacaine is more effective than SC bupivacaine only in decreasing postoperative pain and opioid requirement for hernia wounds.MethodsSixty consecutive male patients undergoing inguinal hernia repair were randomly allocated to one of two groups. Patients in the SC group (S; n = 30) received SC instillation of 10 mL of 0.25% bupivacaine and SF instillation of 10 mL of 0.9% saline, while patients in the combination group (C; n = 30) received SF and SC instillation of 10 mL of 0.25% bupivacaine each. All injections were given in a standardized manner by the surgeon during wound closure. Postoperative pain was scored by means of a 100 mm visual analogue scale.ResultsPain scores at 1, 12 and 24 hours postoperatively were significantly more in group S patients (53 vs. 30, 41 vs. 32 and 22 vs. 15, respectively, p < 0.0001). First time to analgesia was longer in group C (260 ± 17 vs. 137 ± 12 minutes, p < 0.0001). The consumption of pethidine was significantly lower in group C than in group S (23 ± 34 mg vs. 55 ± 42 mg, p = 0.003).ConclusionSF combined with SC instillation of bupivacaine during wound closure prolongs the first time to analgesia, reduces early postoperative opioid requirements and lowers pain in males undergoing open hernia repair.

OBJECTIVE: Data regarding the prevalence of Helicobacter pylori infection and its potential risk factors among schoolchildren from the Middle East is scarce. METHODS: An enzyme-linked immunosorbent assay was used to investigate H. pylori status in four groups of children: The first and second groups, 50 children each (25 boys, 25 girls) included children from high socioeconomic class (group 1 = 6 years old; group 2 = 9 years old). The third and fourth groups were sex- and age-matched, but from low socioeconomic class. To evaluate the association between the seroprevalence of H. pylori and selected risk factors, odds ratios (crude and adjusted) were calculated using multiple regression analysis. RESULTS: Overall seroprevalence rate was 55.5%. Seropositivity was 42%, 52%, 60%, and 68% for groups 1, 2, 3, and 4, respectively. Age and sex were not significantly associated with H. pylori seropositivity. In the final logistic regression model, which was adjusted for age and sex, the following risk factors were found to be significantly associated with seropositivity: living in rural areas (P = 0.015), poor sanitation (P

Gallbladder agenesis is a rare congenital biliary anomaly that may be associated with other biliary and extrabiliary congenital anomalies. Awareness of this entity by clinicians and radiologists is essential because many of these patients present with biliary symptoms and have unnecessary operations. In the present article, the relative epidemiological, etiological (embryology and development), pathophysiological, diagnostic tools and pitfalls and management aspects of this rare anatomic anomaly are briefly discussed through review of the literature. Particular reference to the difficulty in preoperative diagnosis is highlighted. The importance of the possibility of preoperative diagnosis to avoid unnecessary surgery is stressed.

Objective Retained surgical sponges are seldom reported due to medicolegal implications. Awareness of this problem among surgeons and radiologists is essential to avoid unnecessary morbidity. We present our experience with this entity and review the related literature. Methods The medical records of 11 patients who were diagnosed as having retained surgical sponges from 1990 to 2003 were reviewed. Results The incidence was 1:5,027 inpatient operations. There were four males and seven females with a median age of 45 years. The original operations were gynaecological ( n = 4), general ( n = 4), urological ( n = 2) and laminectomy ( n = 1). In seven cases, the original operation was performed on an emergency basis. Five patients were obese. A presumed correct sponge count was documented in eight cases. The median time between the original procedure and diagnosis of retained sponges was 12 months. The tentative diagnosis was intestinal obstruction (4 patients), urinary tract infection (1 patient), Crohn's disease (1 patient) and tumour recurrence (1 patient). The correct diagnosis was suggested in the remaining four patients. Surgical removal of the retained sponges was carried out in all cases except one, in which the patient passed the sponge spontaneously through the rectum. Conclusion Retained sponges are more common in obese patients and after emergency surgery. A high degree of suspicion is important for preoperative diagnosis. Despite the use of radio-opaque sponges and thorough sponge counting, this moribund mishap still occurs. Although human errors cannot be completely abolished, continuous medical training and strict adherence to regulations should reduce the incidence to a minimum.

Background: There is a lack of consistency regarding the prognostic value of cyclin E overexpression in gastric cancer (gastric cancer). Our aim was to report on this overexpression and to analyze its correlations with the clinicopathologic variables. Another aim was to examine if aberrant expression of both cyclin E and p53 might increase the malignant potential of gastric cancer. Methods: Specimens from 89 patients with gastric cancer treated with “curative” intent were evaluated for cyclin E and p53 expressions using immunohistochemical method. The correlations between cyclin E overexpression alone or in combination with p53 expression and the patient's clinicopathologic variables were analyzed. Results: Cyclin E overexpression and p53 expression were shown in 35 (39.3%) and 46 (51.7%) tumors, respectively. The incidence of cyclin E overexpression was significantly higher in deeply invasive cancers (P < 0.0001), in cancers with lymph node metastasis (P = 0.003), and in cancers with advanced stages (P < 0.0001). There were no significant correlations with other clinicopathologic variables. Patients in whom their tumors showed cyclin E overexpression alone or in combination with p53 survived less than patients with negative cyclin E tumors. Multivariate analysis revealed that combined cyclin E overexpression and p53 expression was significantly associated with poor survival after adjusting for other variables (hazard ratio, 3.12; P = 0.009). Conclusions: Cyclin E overexpression is a common event in gastric cancer. Gastric cancer with cyclin E overexpression exhibit increased aggressiveness in the presence of aberrant p53. The combination of cyclin E overexpression with the p53 expression in gastric cancer further distinguished a subgroup of patients with poor prognosis.

Background and Objectives The incidence of malignant peritoneal mesothelioma (MPM) is rising. Our aim was to present our experience with this entity in order to increase the awareness about this disease to avoid misdiagnosis. Methods Records of seven patients with histologically confirmed MPM were retrospectively reviewed. Demographic and clinicopathological findings were studied in detail. Results There were two females and 5 males; mean age was 50.3 years (range 16–73). Asbestos exposure was recorded in two patients, familial Mediterranean fever in one and previous radiation in one. Main presentations were abdominal pain and distension. None of the patients was diagnosed preoperatively. The average delay in diagnosis was 10 months. Calretinin expression was identified in all tumors. Three patients were treated with cytoreductive surgery combined with systemic chemotherapy. Two patients who remain alive were young female patients who were diagnosed by laparoscopic incidental findings and were treated with cytoreductive surgery combined with hyperthermic intraoperative intraperitoneal chemotherapy (HIIC). Median survival was 19.7 months. The average survival time of the five patients who died of their diseases was 10.2 months. Conclusions An awareness of MPM is important to prevent misdiagnosis. Immunohistochemistry has an important role in confirming the diagnosis. MPM remains a difficult therapeutic challenge. Thorough cytoreductive surgery is the cornerstone of current treatment while HIIC is a promising strategy in suitable patients. J. Surg. Oncol. 2005;91:17–25. © 2005 Wiley-Liss, Inc.

Idiopathic granulomatous mastitis is a rare disease of the breast. Clinically and radiologically it may mimic breast carcinoma. Awareness of surgeons, pathologists, and radiologists is essential to avoid unnecessary mastectomies. Data regarding 24 patients with histologically confirmed idiopathic granulomatous mastitis treated at our center over 8 years were analyzed. The mean age of patients was 34.3 years. Breast lump was the most common presentation. The right breast was affected in 16 cases. Four patients were pregnant at the time of presentation. Lactation within 6 months of presentation was documented in four patients. Two patients used contraceptives pills. A clinical suspicion of malignancy was present in 17 cases. Mammography was performed in 16 patients and showed focal asymmetrical dense lesions in 9, well-circumscribed opacity in 4, spiculated lesion in 1, and was normal in 2. Fine-needle aspiration was performed in 17 patients, of which 2 were reported as malignant. Wide local excision was the mainstay of treatment. One patient underwent mastectomy upon clinical, mammographic, and repeated cytologic findings consistent with malignancy, and the final histology confirmed idiopathic granulomatous mastitis with no evidence of malignancy. Four patients developed recurrence after a mean follow-up of 31.2 months. A greater awareness of the rare entity of idiopathic granulomatous mastitis is mandatory to avoid unnecessary mastectomies. Clinical, radiologic, and even cytologic findings are sometimes confused with malignancy. To the best of our knowledge, our patient who developed the disease at the age of 11 years is the youngest reported case.

Background Sources of reports about laparoscopic and percutaneous treatment of liver hydatid cysts are limited to just a few countries. To address the reason behind this, we carried out a survey of 30 surgeons in northern Jordan. Methods A questionnaire was distributed to collect data regarding the surgical technique preferred by each surgeon. Further information was collected from those not adopting minimal-access techniques to determine their reasons for not doing so. Results Only 3 surgeons (10%) considered laparoscopy as the first line of treatment. Of the 27 surgeons who did not consider percutaneous or laparoscopic treatment, fear of anaphylaxis and/or dissemination was the main reason given by 21 surgeons (78%) for not using minimal access techniques. Conclusions The seemingly exaggerated traditional fear of anaphylaxis seems to discourage surgeons from more widely adopting minimal access techniques for the treatment of hydatid cyst.

Background and Aim: To highlight the epidemiological, clinical, and pathological features of gallbladder cancer in Jordan as a model for the Middle East. Only scattered reports are available from this region. Methods: The histopathological reports and the hospital records for all cholecystectomies performed at Princess Basma Teaching Hospital between 1994–2000 were retrospectively reviewed to identify all patients with gallbladder carcinoma. All the histological slides for the cancer group were reviewed and reclassified by a single pathologist. Results: Of 4502 cholecystectomies performed, 33 cases (0.73%) of gallbladder carcinoma were found. The mean age was 61.4 years (range 39–80 years). The male : female ratio was 1 : 3.7. Biliary colic and/or acute cholecystitis were the main presentations. Gallstones were present in 88% (29/33) of the patients. The spectrum of histological subtypes was similar to other series. Only three cases were diagnosed preoperatively, making the incidence of incidental gallbladder cancer 0.66% (30/4502). Simple cholecystectomy was performed for 13 patients. The remaining 20 patients underwent cholecystectomy and portal lymphadenectomy with (five cases) or without (15 cases) extrahepatic resection of the bile ducts. The mean follow up was 22 months (SD ± 18.95 months; range 1–96 months). The 2-year survival rates for stages I, II, III, and IV were 100%, 42.9%, 10.8%, and 0%, respectively (P = 0.0013). Conclusions: The importance of a high index of suspicion when dealing with cholelithiasis in elderly patients, particularly with large sized stones, cannot be over-emphasized. Proper gross inspection in the theater should be a routine procedure performed by all surgeons. Routine ultrasound for suspected gallbladder stones should always be performed under the supervision of senior radiologists.

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.

OBJECTIVES To review the results of a 13-year surveillance programme of patients with Barrett's oesophagus to determine the incidence of adenocarcinoma. Although the risk of cancer in Barrett's oesophagus is well established, the magnitude of this risk is still controversial. DESIGN Records of all patients with histologically confirmed Barrett's oesophagus in our 13-year surveillance programme were examined retrospectively. SETTING Integrated gastroenterology and gastrointestinal surgical service in a large teaching hospital. PARTICIPANTS During the study period, 597 patients had a diagnosis of Barrett's oesophagus; of these, 357 entered a yearly endoscopy and biopsy surveillance programme. MAIN OUTCOME MEASURES The development of oesophageal adenocarcinoma. RESULTS After a mean follow-up of 43 months, 12 patients, all with specialized epithelium, developed adenocarcinoma (11 men), an incidence for men of one cancer per 69 patient-years; and for women, one cancer per 537 patient-years follow-up (P < 0.01). If only patients with specialized mucosa were included the incidence of cancer was one per 95 patient-years of follow-up (men, one per 61 patient-years; women, one per 468 patient-years). CONCLUSIONS Whilst the role of screening patients with Barrett's oesophagus remains controversial, this study supports the routine surveillance of male patients with specialized epithelium.

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.

Gas in the portal veins is rare and in most cases is associated with serious diseases and poor clinical outcome. A case of gas in the hepatic-portal veins with gastric dilatation, as shown by CT-scanning for abdominal trauma, is reported. The condition was clinically benign and resolved spontaneously. An abdominal CT scan documented the findings.

Background: Physical activity has been found to play a role in cancer prevention. The purpose of this matched case-control study was to investigate the association between physical activity levels, water intake, constipation and colorectal cancer (CRC). Materials and Methods: Two hundred and thirty-two patients diagnosed with CRC (125 male, 107 female) were enrolled in this case-control study. Cases were matched to 271 population controls (137 male, 134 female). Results: Drinking more than 4 cups of water daily decreased the risk of CRC by 33-42%; however, this effect was non-significant. Having constipation was found to be a significant risk factor for developing CRC with an OR=6.284 (95%CI=2.741-14.40). With reference to sedentary behavior, minimum activity (600-3000 Metabolic Equivalents Task (MET)) had 43% protection against CRC and the level of Health Enhancing Physical Activity OR was 0.58 (at 95%CI; 0.37-0.92). A significant negative association was found between CRC and physical activity levels expressed as both METs and MET-hours/week (p for trend=0.017 and 0.03, respectively). Among females, a significant trend of reduction in CRC by 62% was observed with increasing the level of physical activity expressed in MET (p for trend=0.04). Conclusions: The risk of CRC may be reduced by adopting a healthy lifestyle and practicing physically activity regularly, especially among females. Consuming adequate amounts of water and healthy bowel motility could also reduce the risk of CRC.

This article seeks to establish the ambiguous nature of Ivan Ilych’s illness in Leo Tolstoy’s novella The Death of Ivan Ilych (1886), and it then proceeds to offer sociocultural commentary on an incurable illness that results in the death of the title character. Regardless of the exact nature of Ivan Ilych’s illness, however, the story suggests that Ivan lived the “wrong” kind of life despite his self-deception and the lies of those around him. Some readers might be intrigued by the mysterious ailment of Ivan Ilych that aggravates into an agonizing death, and some might read the story as a pathography and ponder the doctors’ possible diagnoses alluded to in the text like a floating kidney, a vermiform appendix or a chronic catarrh. While others, on the other hand, might argue for alternative illnesses (not mentioned in the text) allowing for a case like cancer. However, reading the story as a parable to be decoded by physicians using medical expertise does not do justice to its symbolic engagement with illness. It is argued that the text seems to favor a reading that connects ailment to the lifestyle one is following and to one’s own personality or social class. In this regard, the article works at the intersection between the humanities and “medical theories” as adapted for literary ends. Ivan Ilych led the wrong form of life in his pursuit of wealth and hypocritical relations. Therefore, his terminal illness—read as a form of pancreatic cancer—is a figure for an “unhealthy” upper middle-class life lived at the wrong side emotionally, socially and physically. Within the interdisciplinary approach of this article, the metaphorical significance of illness is more important than specifying the exact illness that eventually causes Ivan Ilych’s death because this illness is significantly symbolic beyond its literal sense. Therefore, the symbolic representation/understanding of illness—of cancer in particular—as a social blight or a scourge related to social behavior is insightful for physicians and patients alike.

Choledochal cysts are uncommon developmental anomalies involving intrahepatic and extrahepatic biliary ducts, and their immediate complete excision is recommended to prevent chronic inflammatory and malignant changes. A diagnosis of a congenital type 1C choledochal cyst was made in an 8-year-old female patient admitted to the emergency unit with complaints of severe upper abdominal pain and vomiting. Under laparotomy, resection of the whole segment of choledochal cyst and gallbladder, assisted Roux-en-Y hepaticojejunostomy was performed. The laparotomy approach involving fine dissection and resection of choledochal cysts with Roux-en-Y hepaticojejunostomy remains superior to the endoscopic approach.

The emergence of minimally invasive techniques has broadened interest in splenectomy for a variety of haematological illnesses. Laparoscopic splenectomy (LS) is currently considered the gold standard for the treatment of various haematological disorders.The literature was reviewed to highlight points of consensus and debatable points regarding best practice in LS, looking at issues such as bleeding and conversion, splenomegaly, splenic retrieval techniques, types of instruments used, hand-assisted LS (HALS), complications, approaches, accessory spleen and splenosis. Our goal was to share our experience with LS and compare it with other reports.LS has emerged as the standard of care for elective splenectomy for benign haematological diseases. However, doubts have been raised regarding the suitability of patients with splenomegaly for LS. There is also uncertainty about its efficacy in major trauma. HALS has emerged as an option for safe manipulation and splenic dissection.We performed 25 consecutive LSs at King Abdullah University Hospital (KAUH), Jordan, from 2001 to 2008. Patient demographics, operative time, intra- and postoperative complications, conversion rate, additional procedures and length of hospital stay were retrospectively reviewed.The mean age of the patients was 38.8 years (range 11-77 years), mean operative time was 132 minutes (90- 170 minutes), and length of hospital stay was 2.9 (standard deviation 2.7) days. One case was converted to open surgery (5%). There was 1 case of superficial wound infection in the series (5%), and no deaths.LS is a well- accepted minimally invasive procedure, but knowledge and skill are required to perform it with minimal morbidity and mortality.

Background: The risk of choledocholithiasis is expected to be higher during pregnancy. This is attributed to alteration in bile composition as well as biliary stasis that take place during gestation. There is significant concern regarding application of endoscopic procedures especially the more invasive ones for treatment of choledocholithiasis during pregnancy. Our aim was to provide an additional support to the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the management of biliary diseases during pregnancy. Methods: The medical records of 10 pregnant patients who underwent ERCP at King Abdullah University Hospital, during the period from 2002 to 2007 were reviewed. Pregnancy course and outcomes were followed up in all cases. Results were analysed and compared with published data on safety and efficacy of this procedure. Results: The mean age for mothers was 24.3 years. The mean duration of gestation was 18.4 weeks. Two patients were in the first trimester, five were in their second trimester and another three in the third trimester. The main indication for ERCP was obstructive choledocholithiasis on ultrasound and liver function tests. Fetal radiation exposure was not routinely measured. During, or after, the procedure there was no need for tocolytic agents. Also there was no intrauterine fetal distress. Screening for congenital anomalies was negative in all cases. Conclusion: Major complications of biliary obstruction have been prevented through this procedure. Short-term follow up for all neonates whom mothers underwent ERCP during pregnancy supports its safety. However, specific long-term fetal complications of radiation exposure have not been investigated yet.

Little is known about sigmoid volvulus in the Middle East despite textbooks referring to the region as part of the "volvulus belt." Our objectives were to assess the prevalence, clinical presentations, radiological findings, operative treatments, and postoperative outcomes of patients managed for sigmoid volvulus in Jordan as a model for the region. The medical records of patients with large bowel obstruction who were managed at King Abdullah University Hospital and its affiliated institutes, northern Jordan, over a 6-year period between January 2001 and January 2007 were retrospectively reviewed to identify patients with a confirmed diagnosis of sigmoid volvulus. Sigmoid volvulus was responsible for 9.2% of all cases of large bowel obstruction seen during the study period. There were 32 patients with sigmoid volvulus, 24 (75%) of whom were men. The median age of the patients was 59 years (range 21-83 years). Abdominal pain and distention were the main presentations. Colonoscopic detorsion was applied in 25 patients, which was achieved in 17 (68%) of them after the first attempt. Six patients had a gangrenous sigmoid colon, four of which required resection and a Hartmann procedure. Sigmoid resection with primary anastomosis was performed in 28 patients, including 2 with a gangrenous colon. Postoperative complications were observed in five patients, including one patient with viable colon who develop an anastomotic leak. Two patients died, making the mortality rate 6%. Sigmoid volvulus is uncommon in Jordan. Resection of the sigmoid colon with primary anastomosis appears to be the preferred procedure.

Background: There are very few prospective follow-up studies of Barrett esophagus (BE) cohorts assessing the risk of extraesophageal cancer incidence or mortality. Such studies are necessary in order to understand the overall risks of cancer and death experienced by patients with BE. Methods: A cohort of 502 patients with BE were identified at Leeds General Infirmary, England. Mortality and cancer incidence information were provided by the Office for National Statistics. Standardized mortality ratios (SMR) and standardized incidence ratios (SIR) were calculated using indirect standardization. Results: All-cause mortality was found to be elevated in patients with BE [SMR, 1.21; 95% confidence interval (95% CI), 1.06, 1.37] and remained so after esophageal cancers were excluded (SMR, 1.16; 95% CI, 1.01-1.32). Increased mortality risks were also found for malignant neoplasms of the esophagus (SMR, 7.26; 95% CI, 3.87-12.42) and diseases of the digestive system (SMR, 2.03; 95% CI, 1.11-3.40). The remaining disease categories produced no altered risk estimates. Circulatory disease mortality was borderline statistically significant (SMR, 1.24; 95% CI, 1.00-1.52; P = 0.053) for those with a specialized intestinal metaplasia diagnosis of BE. In the cancer incidence analyses, esophageal malignancies (SIR, 8.66; 95% CI, 4.73-14.53) and esophageal adenocarcinomas (SIR, 14.29; 95% CI, 7.13-22.56) were found to be increased in BE. All remaining analyses provided unaltered risks, including that of colorectal cancer. Conclusions: This study has shown evidence of an increased risk of esophageal cancer incidence and mortality in BE. It has also shown that those who have a histologic BE diagnosis may also have an increased risk of circulatory disease mortality. (Cancer Epidemiol Biomarkers Prev 2007;16(10):2090–6)

Columnar lined esophagus (CLE) or Barrett's esophagus is the precursor for esophageal adenocarcinoma. Future advances in understanding and management of this condition as well as improving the quality of care of CLE patients depends on answering essential questions. It is important to standardize the criteria for CLE definition. The rapid increase in incidence of CLE and adenocarcinoma raises serious concerns that the current management of gastroesophageal reflux disease (GERD) needs reassessment. The risk factors that determine who will and will not develop CLE are as yet undetermined. There is a need to develop a clinical risk stratification tool, which will help in determining who should be screened. The impact of elimination of GERD on the natural history of CLE is one important area for future research. The benefit of surveillance strategies remains unproven and the ideal endoscopic frequency, protocols and markers of cancer risk are unknown. Dysplasia may not provide the gold standard marker of cancer risk because of some inherited problems. A better technique than the current endoscopic pinch biopsy protocol is needed. To overcome the limitations of histological markers, many other markers of cancer risk needs to be developed and validated. The key question as to whether cancer risk is actually reduced by the new ablation modalities remains unanswered. The natural history of dysplasia and its management needs to be clarified. Although many questions have to be answered, it seems, however, that at least some answers exist, and these and proposals for answering some of these questions are underlined throughout this review.

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 ages64 years, whereas all specimens for ages64 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.

Helicobacter pylori (H. pylori) is an important etiological factor in the development of upper gastro intestinal tract (GIT) conditions. A variety of tests are now available to diagnose H. pylori infection but they require a relatively longer time to yield a definitive result. The present work describes fast agar-based urease (FABU) test for detection of the H. pylori in gastric biopsy.One hundred and eighty-seven patients with upper GIT conditions were included in this study for the period from April 2003 to May 2004. One antral biopsy was taken from 100 patients while 2 antral biopsies were taken from 87 patients and inserted into FABU test, in addition to 3-4 biopsies were taken for histology examination.Using one antral biopsy, the FABU test correctly identified 65 of the 78 biopsies positive for H. pylori by histology (83.3%). There were 11 false negative (FN) and 3 false positive (FP). This yields sensitivity of 85.5% and specificity of 87.5%. While when 2 antral biopsies were used, the test correctly identified 61 of 64 H. pylori infected patients (92.2%). There were 3 FP and 5 FN. This yields sensitivity of 92.4% and specificity of 85.7%. Also, the result of this study revealed that 73.2% of the total patients included in this study were infected with H. pylori. Approximately 46.5% were males and 26.7% were females.The results of our study indicate that the FABU test is superior to other commercially available urease tests and provides rapid results of H. pylori status even before the patient is discharged from endoscopy suite.

Objective: To determine indications for circumcision revision and to identify the specialty of the person who performedunsatisfactory primary circumcision.Materials and Methods: The authors reviewed medical records of 52 cases that underwent circumcision revision over a 6-year period (1998 to 2004). Sleeve surgical technique was used for revision in patients with redundant foreskin or con-cealed penis, penoplasty for partial or complete degloving of the penis and meatotomy for external meatal stenosis. Themean age of children was 32 months (range 6 months to 9 years).Results: Most of unsatisfactory primary circumcisions (86.7%) were performed by laymen. All patients who underwentcircumcision revision had good to excellent cosmetic results.Conclusion: Primary circumcision performed by laymen carry a high complication rate and serious complications mayoccur. A period of training and direct supervision by physicians is required before allowing laymen to perform circumcisionindependently.Key words: penis; circumcision; surgical injuries; reoperationInt Braz J Urol. 2006; 32: 454-8

Background The genetic diversity of Helicobacter pylori can be analyzed at two different levels: the genomic variation between strains originating from different individuals, and the variation in bacterial populations within an individual host. We reported for the first time the H. pylori genotypes in Jordanian patients with gastrointestinal diseases. Methods Upper endoscopy was performed on 250 patients with symptoms of gastrointestinal diseases. Multiple gastric biopsy specimens were taken from the antrum. All the biopsies were tested by PCR for the H. pylori virulence genes vacA, cagA, and iceA, and 151 were tested by histology. Results The biopsies positive for H. pylori by PCR were 110/250 (44%), and by histology 117/151 (77.5%), and these results were highly associated (P < 0.02). Analyses of virulence genes revealed that iceA2 (73.6%) was the predominant genotype, the vacAs2 allele was more frequently identified than the vacAs1 allele, while the cagA genotype was low (26.4%). The presence of certain genotypes might be associated with each other, but the presence of certain genotypes was not significantly associated with the age, or gender of the patient. Conclusion The results illustrate the geographic nature of the genetic diversity of H. pylori, as the identified genotypes are similar to those reported in neighboring countries. This study provides a baseline data of H. pylori genotypes identified in gastric biopsy specimens from Jordan, serving as a powerful epidemiological tool for prospective investigations to better understand the genetic diversity of this pathogen.

Since its initial description, the pathogenesis of the columnar-lined esophagus (CLE) has been surrounded by many controversies. The first controversy is related to the existence of the condition itself. The second controversy centers on whether the CLE is a congenital or an acquired condition. In this article, we review the congenital and acquired theories of development of CLE and discuss the various factors in acquisition of CLE. The bulk of evidence in the literature suggests that CLE is an acquired condition.