Kamil M. Fram

Histological analysis of the products of conception following first trimester abortion at Jordan University Hospital.

OBJECTIVE To evaluate the value of histopathological examination of products of conception in first trimester abortion. SETTINGS University hospital. DESIGN Retrospective record review over 2 years, from January 1999 to January 2001. PATIENTS A total number of 293 patients with the diagnosis of first trimester abortion were admitted and their abnormal pregnancy evacuated. RESULTS The highest type of abortion among the studied group was incomplete abortion, 140 patients (48%), and surgical evacuation was the most common method of termination, 202 patients (69%). The histopathology reports confirmed the pregnancy in all patients and revealed partial mole in 51 patients (17%), undiagnosed abnormality in 8 patients (2.7%), suggesting the possible cause for recurrent pregnancy loss in 4 patients (1.4%). CONCLUSION Histopathological assessment for the products of conception proved to be an important tool in detecting molar pregnancy and hydropic changes that necessitate special follow-up protocol and unmasking ectopic pregnancies for further management.

Gastric perforation secondary to metastasis from ovarian cancer: Case report

INTRODUCTION Metastasis from ovarian cancer occurs frequently through the peritoneal cavity in the form of peritoneal carcinomatosis; isolated gastric metastasis is rarely reported in literature. PRESENTATION OF CASE We present a case of 43-year-old infertile lady, who developed a picture of acute abdomen four days post total abdominal hysterectomy and salpingoopherectomy for ovarian cancer. Further contrast-enhanced CT scan demonstrated massive free gas and fluid in the abdomen. She underwent antrectomy with truncal vagotomy due to 3cm×4cm prepyloric gastric ulcer. Final pathology proved the presence of metastatic serous cystadenocarcinoma of ovarian origin. DISCUSSION Our patient had a gastric perforation secondary to ovarian metastasis. Being isolated, the absence of ascites and the transmural nature of the gastric metastasis suggest haematogenous spread .To the best of our knowledge perforated gastric metastasis secondary to ovarian cancer was not reported in literature before. CONCLUSION Gastric metastasis should be kept in mind in patients with a well-known ovarian cancer who present with gastric lesions, ulcers, bleeding or perforation.

Noncompliance with surgical antimicrobial prophylaxis guidelines: A Jordanian experience in cesarean deliveries.

HighlightsCompliance with antibiotic prophylaxis guidelines prior cesareans was evaluated.Overall compliance and compliance with the duration of prophylaxis were poor.Compliance with indication and choice of antibiotic was high.Emergent cesareans reduced noncompliance risk with dose/time of administration.Emergent operations increased the risk of prolonging prophylaxis following surgery. Background: Surgical site infections are common, especially in developing countries. Nevertheless, up to 60% of surgical site infections can be prevented with appropriate perioperative care, which includes among other measures using suitable surgical antimicrobial prophylaxis (SAP). Methods: After a short interview with patients and retrospective review of medical charts, compliance with 6 SAP parameters was assessed for appropriateness; those parameters are indication, choice, dose, time of administration, intraoperative redosing interval, and duration of prophylaxis in 1,173 operations. Results: Overall compliance was poor; nevertheless, certain components showed high compliance rates, such as indication and choice of antibiotics. The most frequent error noted was extended administration of prophylactic antibiotics, which was observed in 88.2% of the study population. Emergency operations were associated with a lower risk of noncompliance in administering the correct dose at the correct time (odds ratio, 0.63; 95% confidence interval, 0.47‐0.83 and odds ratio, 0.21; 95% confidence interval, 0.14‐0.3, respectively). On the other hand, women who underwent an emergency operation were associated with a 6‐fold higher risk of receiving prophylactic therapy following surgery. Conclusions: The present study demonstrated the existence of a surprisingly low level of overall compliance with the hospital‐adapted SAP guidelines. Factors implicated in noncompliance were investigated, and the present results create a starting point to improve the current practice.

Indications for a Hysterectomy at Jordan University Hospital; a Teaching Hospital Experience

Background and Aims: The indications for hysterectomy have changed due to the introduction of many alternatives. However, it is still the most common major gynecological operation. Therefore, this study was conducted to study the indications for a hysterectomy in a teaching hospital. Materials and Methods: This is a retrospective study analyzing the indications for hysterectomy in a teaching hospital over a period of two years (2008-2009). In total, 148 hysterectomies were analyzed. The case notes of these patients were reviewed. Results: The mean age was 46.6 year. Bleeding disorders, uterine fibroids, and abdominal pain were the most frequent indications accounting for 68%. Only 15% were performed due to malignant or premalignant conditions. The final histopathology reports revealed that the most common finding in the uterine specimens was fibroid, which was reported in 50 patients (33.78%), followed by adenomyosis which was reported in 38 patients (25.68%). About 90% of our hysterectomies were carried out through an abdominal route and 10% by the vaginal route. We reported no major complication that endanger the life of the patient as most of the complications were the usual minor postoperative ones ranging from wound infection in 9% to fever and abdominal pain in 1%. Conclusion: The vast majority of hysterectomies were performed to relieve the symptoms of pain, bleeding, or both which means that the indication can be summarized due to discomfort and inconvenience rather than threaten life. It is very clear that age has an important influence on the relative frequency of the indications which are flexible rather than absolute.

Surgical site infections following caesarean operations at a Jordanian teaching hospital: Frequency and implicated factors

Surgical site infections (SSIs) following caesarean surgeries are common. The present study aimed to evaluate the frequency of SSIs following caesareans at Jordan University Hospital during the 30 postoperative days and to identify factors associated with increased SSIs risk. Data regarding the occurrence of SSIs were collected both prospectively via follow-up phone calls and retrospectively via reviewing wound culture results and clinical notes. SSI cases were subsequently determined utilizing predefined criteria. Data relating to possible risk factors of SSIs were collected from patient interviews and hospital records. Risk factors for SSIs were identified via logistic regression. A high rate of SSIs (14.4%) was detected; implicated factors included body mass index ≥36 kg/m2 prior to pregnancy odds ratio (OR) 3.8, 95% confidence interval (95% CI) 1.6–9.4, hospital stay longer than 3.5 days OR 2.3, 95% CI 1.4-3.6, having the operation at a gestational age greater than 40 weeks OR 2.2, 95% CI 1.3-3.9. Receiving a higher weight-adjusted dose of the prophylactic antibiotic cefazolin was associated with lower SSIs risk OR 0.967, 95% CI 0.94-0.99.In conclusion, a high rate of SSIs following caesareans was detected, and modifiable risk factors of SSIs should be incorporated into targeted policies aiming to reduce the rate of SSIs.

Primary myositis and abscess of iliacus muscle due to Brucella.

potential (CMAP) with mild diffuse slowing and absent F-waves. The right radial CMAP was not tested, as it had previously been documented as absent. The right median CMAP was normal, but the amplitude was reduced by 41% compared with the left (9.3 mV right, 5.5 mV left). Please see Supplementary Table S1 (available online) for details. On EMG (Supplementary Table S2), spontaneous activity and reinnervation changes were found in the right first dorsal interosseus, flexor digitorum profundus-4, 5, and extensor digitorum with chronic reinnervation changes of the triceps brachii. Cervical paraspinal, left upper extremity, and right lower extremity EMG was normal. Nerve ultrasonography of the right median, ulnar, and radial nerves was unhelpful, as they were normal other than focal enlargement of the right radial nerve (Supplementary Fig. S1) between the spiral groove and elbow (14 mm). Motor neuron disease and MMN were considered. A motor neuropathy panel (GM1, D1b, GD1a, and MAG antibodies) was negative. An empiric trial of intravenous immunoglobulin (IVIG), 2 g/kg, was administered 2 weeks after initial evaluation. Within a week, he noted the return of finger extension and abduction and regained functional use of the right hand. Examination demonstrated 5/5 right triceps, 4/5 wrist extension, 3/5 finger extension, 3/5 finger abduction, 3/5 thumb abduction and opposition, 4/5 grip, and 5/5 deep finger flexion. He has continued to improve (Figure 1) while receiving IVIG 1 g/kg every 3 weeks over the past 6 months. This report demonstrates a 29-year lapse in stepwise progression of MMN. Despite the absence of antibodies and clear conduction block, the lack of sensory involvement and isolated enlargement of the radial nerve at a site not prone to compression helped suggest a diagnosis of MMN. The dramatic improvement in radial innervated muscles after IVIG was surprising given the duration of deficits and presumed axonal loss. It seems that his initial radial neuropathy was not compressive, but represented the first symptoms of MMN, diagnosed 30 years after onset. Lisa D. Hobson-Webb, MD Stephen N. Donahue, MD Richard D. Bey, MD Department of Neurology, Duke University Medical Center, Durham, North Carolina NovantHealth Winston Neurology, Winston-Salem, North Carolina