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

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

Tuberculous mastitis: a disease not to be forgotten.

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

Feasibility of laparoscopic cholecystectomy in situs inversus.

PURPOSE: To address the feasibility and safety of laparoscopic cholecystectomy in situs inversus and highlight the necessary modifications in the surgical technique. PATIENTS AND METHODS: We present our experience in two patients with situs inversus and symptomatic gallstones who were treated successfully by laparoscopic cholecystectomy. The surgeon stood on the right side with the video monitor above the patient's left shoulder. Two 10-mm ports were placed in the epigastric and subumbilical positions. Two 5-mm ports were placed in the left mid-clavicular and left anterior axillary lines. The two procedures were carried out uneventfully after reorientation of the visual-motor skills of the surgeon and cameraman to the left upper quadrant. A summary of a further similar 13 cases so far treated in the English-language medical literature is also presented. RESULTS: Skeletonizing the structures in Calot's triangle consumed extra time and was more difficult than in patients with a normally sited gallbladder. However, the hospital stay and postoperative complications were similar. CONCLUSION: Laparoscopic cholecystectomy in situs inversus seems to be feasible and safe provided it is performed by an expert laparoscopic surgeon who takes time in clearly demonstrating the extrahepatic mirror image anatomy of the biliary tree with its right-to-left shift.

Fournier's gangrene: changing face of the disease.

PURPOSE: Our experience with ten cases of Fournier's gangrene prompted us to review the related literature to highlight the current status of the disease. METHODS: Data from ten patients with the diagnosis of Fournier's gangrene treated at our center from January 1997 until December 1998 were analyzed. These patients were treated by aggressive resuscitation, triple antibiotics, and urgent surgery. The English-language medical literature for the past 30 years was reviewed. RESULTS: The epidemiologic features of our patients were similar to those reported in other recent studies. Mortality rate was 20 percent. Currently, the disease affects both genders and a wide range of ages, has a more insidious onset than in the past, and is not idiopathic. Associated systemic disorders (diabetes, alcoholism, and immunosuppression) are common. Perianal infection is the commonest cause and is associated with more moribund features. CONCLUSION: The epidemiology of Fournier's gangrene is changing from its original description. Population aging worldwide--as a result of improving health care--and therefore the increasing prevalence of associated medical disorders may explain these changes. These factors may also explain the consistently high mortality rate during more recent years, masking any survival benefits from improved medical care. Better understanding of the pathophysiology has reduced the ratio of idiopathic cases to a minimum.

Torsion of abdominal appendages presenting with acute abdominal pain.

BACKGROUND: Diseases of the abdominal appendages are rare causes of abdominal pain in all age groups. PATIENTS AND METHODS: Nine patients with torsion and infarction of abdominal appendages were retrospectively reviewed. RESULTS: Four patients had torsion and infarction of the appendices epiploicae, four patients had torsion and infarction of part of the greater omentum, and one patient had torsion and infarction of the falciform ligament. The patient with the falciform ligament disease represents the first reported case of primary torsion and infarction of the falciform ligament, and the patient with the transverse colon epiploica represents the first reported case of vibration-induced appendix epiploica torsion and infarction. The patient with the falciform ligament disease presented with a tender upper abdominal mass, and the remaining patients were operated upon with the preoperative diagnosis of acute appendicitis. CONCLUSION: The presence of normal appendix with free serosanguinous fluid in the peritoneal cavity should raise the possibility of a disease, and calls for further evaluation of the intra-abdominal organs. If the diagnosis is suspected preoperatively, CT scan and ultrasound may lead to a correct diagnosis and possibly conservative management. Laparoscopy is playing an increasing diagnostic and therapeutic role in such situations.

Hydatid disease of the breast: a case report and literature review.

Hydatid disease of the breast is rare. However, it might constitute a potentially serious differential diagnosis of a breast lump in areas endemic for this disease. Fine-needle aspiration cytology provides a safe preoperative diagnosis. A case of an isolated breast involvement that was diagnosed during surgery is presented and is followed by a brief discussion on the topic.

Inversion of the normal appendix during the course of abdominal surgery: A procedure not to be forgotten.

Full text is available as a scanned copy of the original print version.

Breast cancer in the North of Jordan with special emphasis on descriptive epidemiology.

Full text is available as a scanned copy of the original print version.

Colorectal adenocarcinoma in a defined Jordanian population from 1990 to 1995.

PURPOSE: This study aims to evaluate cancer of the large bowel as it occurred in a defined Jordanian population, with special reference to its epidemiologic aspects. Second, this study was undertaken to compare these results with those of other countries and those previously reported from Jordan. METHODS: Records of patients diagnosed as having colorectal adenocarcinoma during a six-year period in Irbid province, Jordan, were reviewed. The material was analyzed retrospectively with respect to various epidemiologic features, and the results were compared with those of other countries and those previously published about the Jordanian population. RESULTS: Between January 1990 and December 1995, 109 new patients with colorectal adenocarcinoma were managed, an incidence of 3.8/100,000/year. Male to female ratio was 1:1.05 for colonic cancer and 1.36:1 for rectal cancer. The maximum incidence was seen in the sixth and seventh decades. A total of 12.8 percent of the patients were younger than 40 years of age. The rectum was the most common site involved in 30.3 percent of the patients, followed by the sigmoid, right colon, and the rest of the colon. When compared with previous Jordanian figures, a shift toward the western figures was noted. The delay in diagnosis was noted from the 8.2 months of delay before diagnosis and the advanced stage of the disease at the time of diagnosis. A total of 49.5 percent of the cases were in Dukes B stage, 30.3 percent in Dukes C, and 19.3 percent in Dukes D. Only one patient was in Dukes A stage. A total of 13.8 percent of the cases were mucinous adenocarcinoma. A total of 26.5 percent of the patients presented with complications. CONCLUSIONS: As for colorectal adenocarcinoma, we still share the epidemiologic characteristics of developing countries, but there is a shift toward those of western communities. Flexible sigmoidoscopy is encouraged for evaluation of lower gastrointestinal symptoms, and education of the public and medical staff about colorectal diseases is needed to improve the outcome.