Basil Obeidat

Risk of malignancy index in the preoperative evaluation of pelvic masses

Objectives: To assess the ability of a risk malignancy index (RMI) based on serum levels of CA 125, ultrasound findings, and menopausal status to discriminate between benign and malignant pelvic masses in a particular population. Methods: A retrospective study was conducted of 100 women with pelvic masses admitted for laparotomy. The sensitivity and specificity of serum levels of CA 125, ultrasound findings, and menopausal status were calculated both separately and combined into a RMI to diagnose malignancy. Results: The RMI was more accurate than any single criterion in diagnosing malignancy. Using a cut‐off level of 200 to indicate malignancy, the RMI gave a sensitivity of 90%, specificity of 89%, positive predictive value of 96%, and negative predictive value of 78%. Conclusion: The RMI is able to correctly discriminate between malignant and benign pelvic masses. It is a simple scoring system that can be introduced easily into clinical practice to facilitate the selection of patients who would benefit from primary surgery.

Can Optimal Primary Cytoreduction Be Predicted in Advanced Stage Epithelial Ovarian Cancer? Role of Preoperative Serum CA-125 Level

The aim of this study was to determine the ability of preoperative serum CA-125 levels to predict optimal cytoreduction in patients with stage III epithelial ovarian cancer. A retrospective review was made of the records of 40 patients with FIGO stage III ovarian carcinoma who underwent primary cytoreductive surgery. A receiver operating characteristic (ROC) curve was used to determine the most useful CA-125 level in predicting optimal versus suboptimal tumour cytoreduction. Twenty-two (55%) patients were optimally cytoreduced (residual disease ≤1 cm). A preoperative serum CA-125 level of 500 U/ml was found to be the value with the most predictive power. Optimal cytoreduction was obtained in 16 of the 21 cases (76%) with a CA-125 <500 U/ml compared to only 6 of the 19 cases (32%) with a CA-125 >500 U/ml. At this threshold, preoperative serum CA-125 level was able to predict optimal versus suboptimal cytoreduction with a sensitivity of 72%, specificity of 73%, positive predictive value of 68%, and negative predictive value of 76%. In the management of patients with advanced epithelial ovarian carcinoma, preoperative serum CA-125 level may help to predict optimal primary cytoreduction and to identify candidates for alternative approaches other than traditional primary cytoreductive surgery, such as neoadjuvant chemotherapy.

Bed rest versus free mobilisation following embryo transfer: a prospective randomised study

Objective  To evaluate the efficacy of two clinical methods of post‐embryo transfer protocols in patients undergoing in vitro fertilisation.

Hypothalamic-pituitary-gonadal function in adolescent females with beta-thalassemia major.

Objective: To evaluate the function of the hypothalamic‐pituitary‐gonadal axis in adolescent female patients with beta‐thalassemia major. Materials and methods: A prospective study of the function of the hypothalamic‐pituitary‐gonadal axis function of 31 beta‐thalassemia major females aged between 13 and 22 years and in 12 control females aged between 12 and 22 years. All were treated at Princess Rahma Teaching Hospital, Irbid, Northern Jordan between April 2001 and April 2003. Results: Of the 31 beta‐thalassemia major females, 13 (41.9%) had delayed puberty. Hypothalamic‐pituitary‐ovarian axis dysfunction was found in 15 patients (48.4%). Twelve patients (38.7%) had hypogonadotropic hypogonadism and 5 (16.1%) had ovarian failure. High levels of serum ferritin were significantly higher in patients with delayed puberty. Conclusion: Pituitary and ovarian dysfunction are common problems in beta‐thalassemia major patients. The main possible cause is iron overload. This stresses the need for intensive and regular use of chelation therapy to prevent damage to the hypothalamic‐pituitary‐ovarian axis.

Factors predicting the hematopoietic stem cells content of the umbilical cord blood

Umbilical cord blood (UCB) has been demonstrated to be alternative source of hematopoietic stem cells (HSCs). Unfortunately, the wide use of UCB Transplantation is limited due to the low number of HSCs. The aim of this study was to determine factors that affect the number of HSCs collected from UCB. 200 eligible donors were included for HSCs testing, including total nucleated cells (TNCs) and CD34+ cell number, by using univariate and multivariate analysis. In univariate analysis, factors positively associated with higher number of TNCs were maternal weight (P=0.002), preeclampsia (P=0.03), neonatal weight (P<0.001), neonatal platelet count (P=0.02), neonatal Rh (P=0.03), gestational age (P=0.04) and delivery type (P<0.001). Factors positively associated with higher number of CD34+ cells were maternal weight (P<0.007), preeclampsia (P=0.02), maternal hypertension (P=0.02) neonatal weight (P<0.001), neonatal Rh type (P=0.02) and delivery type (P=0.04). In multivariate analysis, factors significantly influence TNCs were neonatal weight (P<0.001), preeclampsia (P=0.008), neonatal Rh type (P=0.02) and delivery type (P<0.001). While factors significantly influence number of CD34+ cells were maternal weight (P=0.025), neonatal weight (P=0.005), neonatal Rh (P=0.006), nuchal cord (P=0.026) and delivery type (P=0.009). Conclusions factors significantly influence TNCs content of UCB were neonatal weight, preeclampsia, neonatal Rh and delivery type. While factors significantly influence number of CD34+ cells were maternal weight, neonatal weight, neonatal Rh, nuchal cord and delivery type.

Plasma exchange in a woman with thrombotic thrombocytopenic purpura or severe pre-eclampsia

Case reportA 21 year old woman in her first pregnancy attended herlocal hospital at 21 weeks of gestation with mildly raisedblood pressure (130/90 mmHg) and a trace of proteinuria.She had been fit and healthy and her blood pressure andplatelet count were normal. Her sister had idiopathicthrombocytopenic purpura. On admission, her plateletcount was 34 10

Morbidly adherent placenta previa in current practice: prediction and maternal morbidity in a series of 23 women who underwent hysterectomy

Abstract Objective: To assess the prediction and maternal morbidity of morbidly adherent placenta previa (PP) when currently available management options are used. Materials and methods: This is a retrospective study of all women with PP/morbidly adherent placenta previa (MAPP) delivered at our hospital over a period of 9 years. Data were obtained through hospital registry and medical records search Results: A total of 81 PP were identified, 23 (28.4%) of them had MAPP. All MAPP had previous lower segment cesarean section (LSCS). The following are associated with increased odds of MAPP versus PP, LSCS (OR for each additional LSCS was 2.9 (95% confidence interval: 1.8, 4.5, p ≤ 0.005), age ≥35 years (OR 4.3 (95% CI: 1.4, 12.7, p = 0.008). Anterior or central placenta (OR = 11.6; p = 0.028). Women with previous PP were at risk. Fifteen women were diagnosed by ultrasound [sensitivity 0.65 (0.43, 0.83) and PPV 0.79 (0.54, 0.93)]. MAPP was associated with risk of massive transfusion, bladder injury, DIC and admission to intensive care unit (ICU) (p < 0.005, 0.008, 0.036 and 0.008, respectively). One maternal death was reported in the MAPP group. Conclusion: MAPP is associated with high morbidity and mortality. As the diagnosis is often not certain before delivery, we recommend that all PP and previous LSCS are assumed to be morbidly adherent, and should be managed in properly equipped centers.

The diagnosis of endometrial hyperplasia on curettage: how reliable is it?

ObjectiveTo evaluate the consistency of preoperative and postoperative histological findings in cases of endometrial hyperplasia.Materials and methodsFifty-five patients with endometrial hyperplasia detected by surgical curettage were treated by hysterectomy. The histopathological diagnoses found on curettage specimens were compared and correlated with those found on hysterectomy. Endometrial hyperplasia was classified according to the classification scheme of the International Society of Gynecological Pathologists.ResultsFifty-five patients were diagnosed with endometrial hyperplasia on curettage specimens performed for evaluation of various bleeding abnormalities. The average age of the patients was 51.8 years (range 35–74). Thirty patients (55%) were postmenopausal. The interval between curettage and hysterectomy was 1–33 weeks. Of the patients, 26 (47%) had simple hyperplasia, 24 (44%) complex hyperplasia and 5 patients (9%) had complex atypical hyperplasia. Histopathological evaluation of hysterectomy specimens of these patients showed a total number of 35 cases (64%) with endometrial hyperplasia, 1 case of endometrial carcinoma and 19 cases with other pathological findings. The consistency rate between curettage and hysterectomy specimens was 45% (25/55 cases). Following hysterectomy, we found that none of the 26 simple hyperplasia cases and only one of the 24 complex hyperplasia cases coexisted with endometrial carcinoma. On the other hand, three of the five cases of complex atypical carcinoma coexisted with endometrial carcinoma.ConclusionsCurettage endometrial pathology tends to be more consistent with final hysterectomy pathology in simple hyperplasia. However, in cases of complex hyperplasia with atypia, curettage seems to under diagnose the real pathology.

Struma ovarii with pseudo-Meigs' syndrome and elevated CA125 levels

values of CA125 and CA 19-9 in women with benign tumors. Gynecologic and Obstetric Investigation 28:165 – 168. Novakovic S. 2004. Tumor markers in clinical oncology. International Journal of Radiation Oncology 38:73 – 83. Scully RE, Young RH, Clement PB. 1998. Tumors of the ovary, maldeveloped gonads, fallopian tube and broad ligament. In: Rosai J, Sobin LH, editors. Atlas of tumor pathology. Washington DC: Armed Forces Institute of Pathology. Series 3. Fascicle 23. Section 14.3.

Umbilical cord prolapse: A 10-year retrospective study in two civil hospitals, North Jordan

Umbilical cord prolapse (UCP) is an obstetric emergency. The objective of our study was to determine the frequency of cord prolapse, its aetiological factors and to evaluate fetal prognosis. This was a retrospective review of cord prolapse deliveries in the main two civil hospitals in North Jordan between 1995 and 2005, at Princess Badeea Hospital and at King Abdullah University Hospital (KAUH) in Irbid, North Jordan. There were 146 patients identified with UCP among a total of 64,192 consecutive births. The incidence of cord prolapse was one in 440 cases (146/64,192). It occurred mostly in women over 25 years, and significantly more in pre-term births, low birth weight babies, multigravida, and only a few were associated with induced cases. It was not associated with higher rates of perinatal mortality and this supports the benefit of clinical management of UCP by emergency (crash) delivery.