Role of testicular fine needle aspiration in the diagnosis of azoospermia.

Fine needle aspiration (FNA) of the testis is gaining recognition as an important step in the diagnosis of azoospermia. In 1000 azoospermic men receiving a short-acting anaesthetic, each testis was subject to FNA from three standard sites--lower, middle and upper zones--using 26-gauge needles. Azoospermia was graded in the following way: adequate spermatozoa (A1), low, scanty or rare spermatozoa (A2), spermatid arrest (B1), spermatocyte arrest (B2), Sertoli cell-only pattern (C) and sclerosis (D). The FNA grade showed a strong correlation with cell yield, testicular volume and serum follicle stimulating hormone (FSH) levels (all p < 0.0001). Excretory and secretory azoospermia corresponded strongly with FNA grades A1 and A2, respectively. FNA grading was predictive of clinical outcome in terms of sperm yield at testicular sperm extraction, fertilization and pregnancy. In our series, FNA of the testis was relatively free of complications; we recommend its use in the routine diagnosis of azoospermia.

Cervical intraepithelial neoplasia in Jordan: A ten year retrospective cytoepidemiologic study.

Occurrence of cervical intraepithelial neoplasia (CIN) was studied in 10,659 females attending obstetric and gynecology clinics in Jordan. The frequency rate of intraepithelial neoplasia was 1.1% in 7743 Jordanian females and 2916 non-Jordanian residents of younger age during the period from 1982 to 1991 inclusive. The incidence rate in 2649 Jordanian females, selected because they attended only for routine checkup, was 49 per 100,000. There were 121 CIN cases which were graded into Grade I (21%), II (48%) and III (31%) respectively. Histological grading correlated with cytology in 70% of the cases while in the remaining 30%, cytologic underrating by one grade was noted; evidence against any overdiagnosis of CIN in our series. Study of the human papillomavirus (HPV) was outside the scope of this effort. However, circumcision in male partners and marital status were associated with a lower frequency of CIN. Age at marriage and average duration, parity, breast feeding, the contraceptive pill, socioeconomic status and menstrual disorders showed no relationship to the frequency of CIN in our patients. Any differences in the latter between Jordanian and non-Jordanian females are believed due to cultural factors. Conization in 27 cases proved effective at 30 months' follow-up. Occurrence of CIN in Jordanian females appears substantial although much lower than that seen in high incidence zones, while its incidence in the general female population remains to be determined. This study shows for the first time the value of Papanicolaou (Pap) smears in Jordanian females over 20 years of age with special emphasis on those over 35 years of age attending obstetric and gynecology clinics.

Amoxycillin/clavulanic acid (augmentin) compared with triple drug therapy for pelvic inflammatory disease.

Sixty Jordanian women with pelvic inflammatory disease (PID) were studied. Of these, 31 were given oral amoxycillin/clavulanic acid (augmentin) for a mean duration of 8.4 days and 29 were given a standard triple drug regimen of oral ampicillin, intramuscular gentamicin and metronidazole tablets/pessaries for a mean duration of 7.2 days. Bacterial culture (cervical and high vaginal swabs) was positive in every case, most often E. coli but sometimes more than one pathogen was isolated. No gonococci were isolated and tests for chlamydia in 16 patients (8 in each group) were negative, suggesting a dissociation between the etiology of PID and sexually transmitted disease in this Jordanian study. After 3 days of treatment, more patients in group I (augmentin) showed diminution of symptoms of pain and discharge (P less than or equal to 0.05) compared to group II. At the end of treatment, complete cure or satisfactory improvement was recorded in 93.1% and 92.9% of cases in the two groups, corresponding to in vitro bacterial efficacy of 90.4% and 96.5%, respectively. No serious side effects were noted in either regimen. The results of this comparative study suggest that oral amoxycillin/clavulanic acid (augmentin) may be a convenient alternative to the triple drug regimen usually administered for the treatment of pelvic inflammatory disease.

Epidemiology and diagnosis of human brucellosis in Jordan.

In recent reports, brucellosis has emerged as an important public health problem in the east Mediterranean region and Jordan is no exception. In 1986 and 1987, the minimal incidence rates per 100,000 persons in Jordan were 33.2 and 46.2, respectively, with no sex difference. Low incidence rates were confined to those below 4 and over 55 years of age. A seasonal incidence seen in 1986 was repeated in 1987 with maximal rates in the spring and summer months, exhibiting a strong connection with the lambing season. In-vitro sensitivity of 43 isolates of Brucella melitensis is presented. Endemicity in animals is discussed because of its direct relationship with the disease in man.

A study of 405 breast tumors in Jordanians using the Revised WHO classification.

From the files over the period 1980-85 in two pathology centers in Amman, 405 breast tumors were classified according to the Revised WHO International histological classification; the pattern found resembled that reported from other countries. 228 tumors were malignant (80% invasive ductal) and 177 were benign (83% fibroadenomas). Tumor size as stated in pathology reports ranged between 1 and 8 cm with an average of 3.3 cm, 83% being larger than 2 cm. In only 110 malignancies, mastectomy specimens were submitted and 76% of them showed axillary lymph node involvement, in half affecting four or more lymph nodes. Interestingly, average size of fibroadenomas was 2.9 cm, so that for benign and malignant tumors alike, patients initially presented after the tumor had reached considerable size. Average age of cancer patients was 45 years; 46% were younger than 45 years of age. This study stresses standardization of histologic classification and the need to introduce early detection techniques in order to improve the outcome.

Intrauterine bone contraceptive device: an accident of nature.

Ultrasonography and hysterosalpingography led to discovery of four bony plates retained in the uterine fundus after an abortion 33 months earlier and which had apparently led to secondary infertility in a 26-year-old woman. Removal of the bony plates was soon followed by a successful pregnancy.

PIP: The case is described of a 26-year olf woman, gravida 2, para 1, who presented with failure to conceive 18 months after revomal of a Lippes Loop IUD worn for 12 months. The IUD had been inserted following a miscarriage at 18 weeks gestation, in which vaginal evacuation was bloody and difficult. The patient had a normal menstrual cycle and normal blood loss. The pulse, blood pressure, temperature, and pelvic examination were normal. A postcoital test was satisfactory, the tubes were patent, and serum levels of follicle stimulating hormone, luteinizing hormone, prolaction, progesterone at days 18 and 22, and testosterone were all normal. The pelvic ultrasonogram showed a persistent focus of intrauterine illumination, and hysterosalpingography revealed an irregularity in the right cornu. Results of laparoscopy were negative. 4 thin plates of bone, each 10 mm in the long axis, were removed at an exploratory dilatation and curettage. Microscopic examination showed necrotic bony trabeculae and bone marrow in the intervening spaces. A pregnancy test was positive 3 months later and patient gave birth to a health female weighing 3.3 kg. In both this and a similar previously reported case, the bone fragments were located in the fundus. The contraceptive action was possibly related to an increase of prostaglandin concentration in the fundal endometrium, which is a common site for blastocyst implantation. Prolonged intrauterine retention of fetal skeletal parts should be added to the list of possible causes fo secondary infertility.

Colorectal juvenile polyps: an epidemiological and histopathological study of 144 cases in Jordanians.

The minimal incidence rate of colorectal juvenile polyps in Jordanians was 1.4 per 100 000 in the general population and 2.8 per 100 000 in children under 10 years of age. Out of 144 cases, nine had two to seven polyps and one juvenile polyposis coli. There was male preponderance and a mean age of 8 years: 96.5% of the polyps were in the rectum. Characteristically, stromal oedema, inflammation, ulceration with granulation tissue cap formation and gland regeneration were present. Epithelial hyperplasia was not uncommon and focal dysplastic change was occasionally noted, being always accompanied by hyperplastic change. Focal severe dysplasia was seen in one solitary juvenile polyp. It is concluded that varying degrees of focal epithelial atypia can occasionally develop in solitary juvenile polyps, rarely reaching severe dysplastic change. Malignant transformation in the commonly seen form of juvenile polyp (solitary type) is probably a rare phenomenon, but its frequency needs further evaluation.

Primary gastrointestinal lymphoma in Jordan.

This study presents striking differences in the occurrence of gastric and intestinal lymphomas in Jordan, demonstrating a picture similar to that reported in the Mediterranean zone but different from that in Western countries. In 47 Jordanians, the ratio of gastric to intestinal cases was 1:2.6; mean ages were 53 and 18 years respectively; and peak incidence rates were 1.1 and 1.2 in males 35-64 years old old and children below the age of 10 years, respectively. Lymphoma constituted 7% of gastric and 90% of intestinal malignancies. Gastric lymphoma generally presented at an earlier clinical stage. Ileocaecal lymphoma accounted for 21% of gastrointestinal lymphomas, occurring in children below the age of 10 years, with preponderance of the diffuse large cell type; 90% presented in clinical stage II. Annual minimal incidence of gastrointestinal lymphoma was 0.5 per 100.000 in the Jordanian population. It is envisaged that with the progressive change of Jordanians' habits towards a Western style, follow up studies have to be awaited to detect any possible changes in the pattern of primary gastrointestinal lymphoma in this population.

Acute leukemia in pregnancy: report of five cases treated with a combination which included a low dose of adriamycin.

Five cases of acute leukemia which developed in the course of pregnancy are reported. All five cases received combination therapy which included adriamycin. Two cases were treated during the first half of pregnancy. One of them aborted 2 weeks after commencing therapy but had severe homeostatic failure. The second had a successful pregnancy and delivered a normal infant. Three cases were treated during the second half of pregnancy. All had normal pregnancies and delivered normal infants. The babies have been followed up for periods ranging from 1 month to 3 yr and have shown normal growth and development.

Colorectal cancer in Jordan and Nova Scotia: a comparative epidemiologic and histopathologic study.

A comparative study of colorectal adenocarcinoma was undertaken among the populations of Jordan and Nova Scotia, Canada. The incidence of this cancer was 13 (colon 6, rectum 7) and 53 (colon 31, rectum 22) per 100,000 males aged 35--64 years, respectively. Colonic tumors (excluding rectosigmoid) showed left-sided preponderance in Jordanians and right-sided preponderance in Nova Scotians. Age average at diagnosis was 49 years in Jordanians (colon 47 years and rectum 50 years) and 66 years in Nova Scotians (colon 67 years and rectum 63 years), with peaks in the fifth and seventh decades and a male to female ratio of 1.3:1 and 1:1, respectively. The mucinous type accounted for 31 and 13% of colorectal adenocarcinomas in Jordanians and Nova Scotians, respectively, of which the signet-cell type accounted for 14 and 2% of the total number, respectively. The actual incidence rate of mucinous carcinoma, however, was higher among Nova Scotians. In both groups, mucinous carcinoma showed predilection for females and rectal signet-cell carcinoma showed bias toward younger females. The authors believe that the significantly different epidemiologic and morphologic features of colorectal cancer demonstrated in these two communities could shed light on possible etiologic influences, such as dietary habits or other environmental factors.

Bilateral tubal pregnancy in the presence of an IUD: a case report.

Bilateral tubal pregnancy was confirmed by histologic examination in a 32-year-old multipara with an intrauterine contraceptive device (IUD) in situ. The patient had developed intraperitoneal bleeding and hypovolemic shock. Bilateral salpingectomy was performed and was followed by a rapid recovery.

Hepatoma causing a massive tumour embolus.

A case of hepatoma is reported, with a typical clinical setting but a most unusual and dramatic final episode. A massive tumour embolus weighing 30 g became arrested on the tricuspid valve, resulting in acute circulatory failure.

Luekemic infiltration of the prostate: a case study and clinicopathological review.

A case of leukemic infiltration of the prostate occurring with acute retention of urine is reported. Examination of the blood showed chronic lymphocytic leukaemia (CLL). The number of reported cases of leukemic infiltration of the prostate is updated and a review of the literature on the subject is presented.