Nawaf J. Shatnawi

Idiopathic Granulomatous Mastitis: Time to Avoid Unnecessary Mastectomies

Abstract:  Idiopathic granulomatous mastitis is a rare disease of the breast. Clinically and radiologically it may mimic breast carcinoma. Awareness of surgeons, pathologists, and radiologists is essential to avoid unnecessary mastectomies. Data regarding 24 patients with histologically confirmed idiopathic granulomatous mastitis treated at our center over 8 years were analyzed. The mean age of patients was 34.3 years. Breast lump was the most common presentation. The right breast was affected in 16 cases. Four patients were pregnant at the time of presentation. Lactation within 6 months of presentation was documented in four patients. Two patients used contraceptives pills. A clinical suspicion of malignancy was present in 17 cases. Mammography was performed in 16 patients and showed focal asymmetrical dense lesions in 9, well‐circumscribed opacity in 4, spiculated lesion in 1, and was normal in 2. Fine‐needle aspiration was performed in 17 patients, of which 2 were reported as malignant. Wide local excision was the mainstay of treatment. One patient underwent mastectomy upon clinical, mammographic, and repeated cytologic findings consistent with malignancy, and the final histology confirmed idiopathic granulomatous mastitis with no evidence of malignancy. Four patients developed recurrence after a mean follow‐up of 31.2 months. A greater awareness of the rare entity of idiopathic granulomatous mastitis is mandatory to avoid unnecessary mastectomies. Clinical, radiologic, and even cytologic findings are sometimes confused with malignancy. To the best of our knowledge, our patient who developed the disease at the age of 11 years is the youngest reported case. 

Meckel's Diverticulum: Comparison of Incidental and Symptomatic Cases

Although Meckel’s diverticulum is the commonest congenital gastrointestinal anomaly, there is still debate concerning the proper management of asymptomatic diverticula. Records of all patients whose Meckel’s diverticulum was resected at our hospitals between 1990 and 2002 were reviewed. Clinical characteristics, mode of presentations, and management for all patients were analyzed. Meckel’s diverticula were resected in 68 patients. Patients were divided into two groups: the incidental group included 40 patients (24 males) in whom the diagnosis of diverticula was incidental. The symptomatic group included 28 patients (20 males) who presented with diverticulum-related complications. Preoperative diagnosis was possible in only four cases. In four patients from the symptomatic group, Meckel’s diverticula were found and left untouched during a previous laparotomy. There was no significant difference between the two groups with respect to gender (p = 0.48). Patients in the symptomatic group were significantly younger than patients in the incidental group (p = 0.002). The diverticula in the symptomatic group tended to be longer (p = 0.001) with a narrower base (p = 0.001) than the diverticula in the incidental group. A diameter of ≤ 2 cm was significantly associated with more complications (p = 0.01). Heterotopic tissue was present more significantly in the symptomatic group than the incidental group (p = 0.01). There was no significant difference in the morbidity rate between the two groups (p = 0.71), and there was no mortality in either group. Preoperative diagnosis of Meckel’s diverticulum is difficult and should be kept in mind in cases of acute abdomen. Resection of incidentally found diverticula is not associated with increased operative morbidity or mortality.

Quality of life and associated factors among Jordanian adolescents with type 1 diabetes mellitus

OBJECTIVES Quality of life (QoL) is a significant indicator of the outcome of the treatment in chronic diseases. The purpose of the study was to assess the QoL of Jordanian adolescents with type 1 diabetes mellitus and its associated factors. METHODS A total of 145 adolescents with type 1 diabetes mellitus were invited to participate in the study during their regular visits to outpatient clinics. The subjects were recruited from the National Center for Diabetes, Endocrine and Genetic Diseases in Amman, the capital of Jordan, and from three main hospitals in the north of Jordan between October 2007 and February 2008. A short form of the Diabetes Quality of Life for Youth (DQLQY-SF) questionnaire was used. The DQLQY-SF consists of 22 items on two subscales (disease impact and worries) with higher scale scores indicating increase frequency of problems and lower QoL. RESULTS The mean (S.D.) age of the participants was 14.1 (3.1) years and the mean (S.D.) diabetes duration was 3.7 (2.9) years. This study showed that adolescents perceived their QoL as low. The mean (S.D.) of DQLQY-SF total score was 56.4 (18.0). The mean was 36.2 (10.1) for the impact scale, 17.9 (8.9) for worries about diabetes, and 2.2 (1.2) for health perception. Multivariate analysis showed that more impact of diabetes, worries about diabetes, and worse overall QoL were associated with shorter diabetes duration, higher HbA(1c) values, being a girl, and older age. CONCLUSIONS The QoL of Jordanian adolescents with type 1 diabetes was low. Better glycemic control may contribute to the improvement of QoL.

Reasons for cancellation of elective operations at a major teaching referral hospital in Jordan.

Cancellation of elective scheduled operations leads to an inefficient use of operating room time and a waste of resources. This prospective records-based study aimed to determine the rate of and reasons for cancellations of scheduled elective surgical operations in a major teaching referral hospital in Jordan. Over a period of 12 months, cancellation was recorded in 382 (3.6%) of 10 485 scheduled elective surgical operations. Day unit cancellations accounted for 27.5% and inpatient cancellations for 72.5%. Patient-related reasons, administrative and medical reasons accounted for 31.4%, 30.4% and 38.2% of all cancelled operations respectively. The most common patient-related reason for cancellation was patient non-attendance. The most common administrative reason for cancellations was unavailability of hospital admission beds. Although the cancellation rate was low in comparison with the reported rates worldwide, reductions might be achieved by adopting some important interventions, especially better bed utilization.

Gallbladder cancer in northern Jordan

Background and Aim:  To highlight the epidemiological, clinical, and pathological features of gallbladder cancer in Jordan as a model for the Middle East. Only scattered reports are available from this region.

Predictors of major lower limb amputation in type 2 diabetic patients referred for hospital care with diabetic foot syndrome

Purpose This study was conducted to determine the risk factors of major lower extremity amputations in type 2 diabetic patients referred for hospital care with diabetic foot syndrome. Patients and methods This retrospective study involved 225 type 2 diabetic patients referred for management of diabetic foot syndrome at King Abdullah University Hospital in the period between January 2014 and December 2015. A structured customized diabetic foot data collection form with diabetic foot characteristics chart was used for documentation of relevant information, which checks for age, sex, body mass index, smoking, duration of diabetes, diabetic control therapy, associated hypertension, cardiac diseases, stroke, chronic renal impairment, renal replacement therapy (hem-dialysis), and history of diabetes-related complication in both feet prior to the study period. The predictors for major lower limb amputations were compared between groups using chi-square test, and binary logistic regression was used to determine the factors associated with major amputation. Results Twenty-seven limbs underwent major amputations with an overall rate of major amputation of 11.6%. The following predictors were found to be associated with the higher incidence of major lower limb amputations: duration of diabetes ≥15 years, HbA1c ≥8%, patients on insulin, with hypertension, cardiac diseases, chronic renal impairment, stroke, having gangrene, higher number of components, higher Wagner classification, and ischemia. However, the rate did not differ significantly between men and women. Conclusion Presentation with gangrenous tissue and poor glycemic control are the important risks and significant predictive factors for type 2 diabetes-related major lower limb amputations.