Unusual histopathological findings in appendectomy specimens with clinical diagnosis of acute appendicitis: A retrospective cohort analysis.

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.

Dietary and Lifestyle Factors Associated with Gastric and Pancreatic Cancers: A Case-Control Study.

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.

Medical students' vs. consultant surgeons' view of anatomy knowledge / Opinión de los estudiantes de medicina vs. cirujanos consultores sobre el conocimiento de la anatomía

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.

La anatomía es considerada la base de la cirugía. Los cirujanos a menudo se quejan de las deficiencias en el nivel de conocimiento anatómico de su médico subalterno. El objetivo del estudio fue comparar las opiniones de los estudiantes de medicina y los cirujanos consultores del último año con respecto a los métodos actuales de enseñanza de anatomía y los métodos que deben utilizarse para mejorar el conocimiento de la disciplina de los estudiantes de medicina. Se desarrollaron dos cuestionarios: uno para cirujanos consultores y otro para estudiantes de medicina. Estos cuestionarios encuestaron a cirujanos consultores y estudiantes de medicina de alto nivel con respecto a sus puntos de vista sobre diversos aspectos de la enseñanza de anatomía de pregrado, que incluyen: aumentar el tiempo para la enseñanza de anatomía, el nivel de conocimiento de anatomía, la participación de los cirujanos en la enseñanza, los mejores métodos de enseñanza y el examen de anatomía, áreas de fortaleza y debilidad entre los estudiantes, y la adecuación de la enseñanza actual para comprender imágenes de radiología, vistas laparoscópicas y endoscópicas. La tasa de respuesta de consultores y estudiantes fue del 62,6 %. Los cirujanos que señalaron aumentar el tiempo para la enseñanza de anatomía de pregrado fue en el 77,1 %. Un porcentaje significativo de cirujanos y estudiantes consideraron que su nivel de conocimiento anatómico entre cirujanos subalternos y estudiantes era bajo (63,4 % y 46,6 %, respectivamente). Además, más de dos tercios de los cirujanos y estudiantes estimaron que la participación de los cirujanos en la enseñanza de anatomía en los primeros 3 años en las escuelas de medicina puede ser útil (68,0 % y 69,0 %, respectivamente). La enseñanza en el cadáver fue seleccionada como el mejor método de enseñanza de anatomía por 81,0 % de cirujanos y 79,6 % de estudiantes. Sólo el 33,1 % de los cirujanos y el 35,4 % de los estudiantes pensaron que nuestra enseñanza actual de anatomía era adecuada para entender las vistas radiológicas, laparoscópicas y endoscópicas. Los cirujanos y los estudiantes estuvieron de acuerdo con respecto a los reducidos niveles de conocimiento anatómico de los estudiantes. Un aspecto particular de tal privación fue la incapacidad de los estudiantes para interpretar imágenes radiológicas, vistas laparoscópicas y endoscópicas. Puede ser beneficioso aumentar el tiempo dedicado a la enseñanza de la anatomía, involucrando a cirujanos en el proceso de enseñanza de la anatomía y redirigiendo el enfoque a la disección del cadáver.

Medical students perception of current undergraduate anatomy teaching / Percepción de estudiantes de medicina de la enseñanza actual de anatomía en el pregrado

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.

La anatomía es una de las ciencias básicas que forma parte de los primeros 3 años del currículo de enseñanza en las escuelas de medicina. El objetivo de esta encuesta fue explorar la percepción de los estudiantes de medicina en la enseñanza de la anatomía en diferentes escuelas de medicina e identificar los puntos débiles y el área en que podrían ayudar a mejorar el proceso de enseñanza con obtención de mejores resultados. Se realizó un estudio prospectivo multicéntrico, entre mayo de 2018 y agosto de 2018, aplicándose un cuestionario a 313 estudiantes de medicina en su año de pasantía y 6º año. El cuestionario se envió a los estudiantes teniendo en cuenta la importancia de proteger la privacidad de los mismos. El cuestionario se elaboró después de una revisión exhaustiva de la literatura y sus ítems se seleccionaron luego de consultar con colegas médicos y educadores de alto nivel. El cuestionario se creó utilizando una escala de Likert de 8 elementos para imponer una respuesta y evitar una respuesta neutral. De los 313 estudiantes: 212 eran mujeres (67,7 %) y 101 (32,3 %) hombres; 123 estudiantes (39,3 %) apoyaron la combinación de disección de cadáveres y multimedia como mejores métodos de enseñanza. La mayoría de los estudiantes pensaron que los métodos clásicos de enseñanza pueden no ser muy útiles para comprender las imágenes radiológicas y las vistas intraoperatorias laparoscópicas. La mayoría de los estudiantes sugirió que involucrar a los cirujanos en la enseñanza de anatomía podría mejorar su conocimiento clínico en anatomía. Nuestros resultados mostraron que el enfoque de la enseñanza podría mejorarse combinando múltiples técnicas, especialmente la disección de cadáveres y las sesiones multimedia. Los resultados también indican que las escuelas de medicina deberían involucrar a los cirujanos en la enseñanza de la anatomía.

Fast Foods, Sweets and Beverage Consumption and Risk of Colorectal Cancer: A Case-Control Study in Jordan

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.

Cystic echinococcosis in Jordan: A review of causative species, previous studies, serological and radiological diagnosis.

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.

Dietary inflammatory index and odds of colorectal cancer in a case-control study from Jordan.

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.

Dietary patterns and colorectal cancer.

BACKGROUND & AIMS: Dietary 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. METHODS: Dietary 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. RESULTS: Factor 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. CONCLUSION: The 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.

Consumption of Whole Grains, Refined Cereals, and Legumes and Its Association With Colorectal Cancer Among Jordanians.

Background The role of whole grains, refined cereals, and legumes in preventing or initiating colorectal cancer (CRC) is still uncertain. The aim of this study is to examine the possible association between the consumption of whole grains, refined cereals, and legumes and the risk of developing CRC among Jordanian population. Methods A validated food frequency questionnaire was used to collect dietary data with regard to intake of whole grains, refined cereals, and legumes. A total of 220 diagnosed CRC participants and 281 CRC-free control participants matched by age, gender, occupation, and marital status were recruited. Logistic regression was used to estimate the odds of developing CRC in relation to the consumption of different types of whole grains, refined cereals, and legumes. Results The odds ratio (OR) for developing CRC among cases consumed refined wheat bread at all meals was 3.1 compared with controls (95% CI: 1.2-7.9, P-Trend = 0.001); whereas the OR associated with whole wheat bread was 0.44 (95% CI: 0.22-0.92, P-Trend = 0.001). The statistical evaluation for daily consumption of rice suggested a direct association with the risk of developing CRC, OR = 3.0 (95% CI: 0.27-33.4, P-Trend = 0.020). Weekly consumption of macaroni was associated with CRC with OR of 2.4 (95% CI: 1.1-5.3, P-Trend = 0.001). The consumption of corn, bulgur, lentils, and peas suggested a protective trend, although the trend was not statistically significant. Conclusion This study provides additional indicators of the protective role of whole grains and suggests a direct association between consumption of refined grains and higher possibility for developing CRC.

Macro- and micronutrients consumption and the risk for colorectal cancer among Jordanians.

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.

Food groups and the risk of colorectal cancer: results from a Jordanian case-control study.

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.

Fruit and vegetable intake among Jordanians: results from a case-control study of colorectal cancer.

BACKGROUND: Diets that include fruits and vegetables have been suggested as one way to reduce the risk of developing colorectal cancer (CRC); however, the association between consuming fruits and vegetables and CRC risk is not clear. The objective of the present study is to compare fruit and vegetable intake between 2 groups of Jordanians and further investigate this possible relationship. METHODS: A history of fruit and vegetable consumption was obtained from 220 people with CRC and 281 healthy controls, all of whom were from Jordan. Both groups were matched for age, sex, occupation, and marital status. Fruit and vegetable consumption was quantified for the previous 12 months in both groups. RESULTS: Total vegetable intake was associated with the risk of developing CRC. Consuming 5 servings of vegetables a day decreased the risk of developing CRC when compared with no more than 1 serving a day (odds ratio [OR] = 0.23; 95% confidence interval [CI]: 0.55-0.97). A significant direct relationship between CRC risk and consuming cauliflower and cabbage was found; however, no association was found for raw or cooked leafy vegetable and other vegetable types. Consuming several types of fruits also revealed no association with risk of CRC, although an increased intake of dates and figs was associated with a reduced risk of developing CRC. The ORs for the highest intake of servings compared with the lowest intake were 0.48 (95% CI: 0.27-0.87; P = .004) for dates and 0.604 (95% CI: 0.35-1.06; P = .003) for figs. CONCLUSIONS: Consuming fruits and vegetables did not significantly correlate with a lowered incidence of CRC. However, a trend of protection was detected for several types of fruits and vegetables.

Anti-Helicobactor pylori activity of some Jordanian medicinal plants.

CONTEXT: 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. OBJECTIVE: In this study, we evaluated the effect of extracts of 16 medicinal plants grown in Jordan against clinical isolates of H. pylori. MATERIALS AND METHODS: 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: 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. DISCUSSION AND CONCLUSION: Jordanian medicinal plants might be valuable sources of starting materials for the synthesis of new antibacterial agents against H. pylori.

Validation of a food frequency questionnaire to assess macronutrient and micronutrient intake among Jordanians.

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.

Physical inactivity, water intake and constipation as risk factors for colorectal cancer among adults in Jordan.

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.

Congenital Type 1C Choledochal Cyst: Clinical Presentation and Surgical Treatment.

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.

Laparoscopic splenectomy: consensus and debatable points.

INTRODUCTION: 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. PURPOSE: 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. BACKGROUND: 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. METHOD: 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. RESULTS: 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. CONCLUSION: LS is a well- accepted minimally invasive procedure, but knowledge and skill are required to perform it with minimal morbidity and mortality.

Safety of endoscopic retrograde cholangiopancreatography during pregnancy.

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.

Jejunal disorders: potentially lethal causes of acute abdomen are still overlooked.

OBJECTIVE: To highlight the importance of considering jejunal disorders in the differential diagnosis of acute abdomen. Although these conditions are relatively uncommon, we should keep in mind that jejunum still occurs, and deserves consideration. METHOD: This study was carried out at King Abdullah University Hospital, Jordan. Medical records of 7 patients with uncommon jejunal disorders that were encountered between 2001 and 2007 were retrospectively evaluated. We had 1 patient with jejunal diverticulitis, 1 with jejunal intussusception, 2 with jejuno-ileal tuberculosis complicated by intestinal obstruction, and 3 with acute mesenteric ischemia. All of these patients presented with acute abdominal pain of nonspecific features. Radiologic workup, along with surgical intervention, was necessary to reach a final diagnosis. RESULTS: Only 1 patient matched preoperative diagnosis, in which computed tomography scan revealed the presence of intussusception. The remaining patients were diagnosed intraoperatively. Laparoscopy and/or laparotomy with resection were performed. Morbidity was within acceptable range. There was no mortality. CONCLUSIONS: Jejunal disorders are potentially serious, and are underestimated. They are considered important causes of acute abdomen. Although they should not be at the top of a differential diagnostic list, they should always be ruled out when there is no apparent cause.

Iatrogenic gastric dilatation: a rare and transient cause of hepatic-portal venous gas.

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.