Jordan Medical Journal

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 Dr Mustafa Shennak by Email, please include your postal address for the Attention of Dr. Shennakm@go.com.jo

Editor- in – Chief Editor

Mustafa M: Shennak Mazen Bdour

Tel: 9626 - 568 6616 / 5665620

Fax: 9626- 568 6435 

editorial Board

Abdalla Abbadi Walid Obeidat

Munib Ayoub Sameer Otoum

Abdallah Bashir Yousef Othman

Muawyah Al-Bdour Khalaf Rakkad

Abdel Hadi S. Breizat Abdallah Saadeh

Naif Karadsheh Mahmoud Al-Sheyyab

Moh’d El Lozi Ahmad Tamimi

Aly Misha’l

Editorial Assistant Editorial Secretary

David Todd Rafif Zaim

Former Editor – In – Chief

Mahmoud Abu-Khalaf Saad Hijazi

Kamel Ajlouni Fouad Kilani

Saleh Armouti Hasan Pharaon

Mahmoud Fayyad Fuad Sayegh

Review Article

Insulin from Discovery to Analogues 80

Enas Younis, Kamel Ajlouni.

University Hospital, Amman, Jordan.

Original Articles

The Value of a Trophoblast Tumor Registry in Jordan 86

Mahmoud Amr.

Amman, Jordan………………………………………………………………

An Appraisal of Computed Tomography Pelvimetry in Patients 89

With a Previous Cesarean Section

Yaser Abu-Ghazzeh, Rafic Barqwi

Prince Hashem Ibn Al Hussein Hospital, Royal Medical Services, Zarka, Jordan…………………………………………………………………………

HLA Class I Alleles Association and Seroreactivity to Common 93

Disease

Abdel Jalil Thewaini, Khalid Matalka, Ali Fadel Jassim and

Thabit Al-Heeti.

Hospital, Baghdad, Iraq……………………………………………………..

Are Magnetic Resonance Imaging or Computerized Tomography 100

Required for Tension Headache?

Mohammed Hiari, Mohammed Ghatasheh.

Department of Radiology, King Hussein Medical Center, Amman, Jordan…………………………………………………………………………

Lacrimal Punctoplasty with Mitomycin C 102

Atef Tahat.

Department of General Surgery, King Hussein Medical Center, Amman Jordan..……………………………………………………………………….

Complication of Laparoscopic Cholecystectomy: Analysis of 105

1340 Cases

Hanan Rihani, Basheer Al-Jarrah

Jordan…………………………………………………………………………

Lactate Dehydrogenase Enzyme Activity in Cerebrospinal Fluid 112

and Serum in Patents with Benign Intracranial Hypertension

Ahmad Faleh Tamimi.

Jordan………………………………………………………………………….

Clinical Patterns of Cerebral Palsy in 202 Jordanian Patients 116

AbdelKarim Al-Qudah, Salameh Abu-Sheikh.

Department of Pediatrics, Jordan University Hospital, Amman, Jordan…………

Case Report

Server Upper Gastrointestinal Bleeding in a Healthy Full-Term 121

Neonate

Muna Kawar.

Department of Pediatrics, King Hussein Medical Center, Amman,

Jordan……………………………………………………………………

Book Reviews 125

Hemostasis & Thrombosis: Edited by TG Deloughery.

Clinical Hematology: Principles, Procedures, Correlations: Edited by EA Stiene – Martin, CA Lotspeish –Steininger and JA Koepke.

The Value of a Trophoblast Tumor Registry in Jordan

Mahmoud Amr.

Department of Obstetrics and Gynecology, Jordan University Hospital, Amman, Jordan.

Abstract

The incidence of molar pregnancy at our hospital was 3.8 per 1000 deliveries. The incidence of hydatiform mole in Jordan is not known because of the lack of a registry. There is a need to establish a registry in the country for this disease. Also these cases should be managed at specialized centers.

Keywords: Gestational trophoblastic tumors, Hydatidi- form mole, Human chorionic gonadotrophin, Beta subunit of hCG.

An Appraisal of Computed Tomography Pelvimetry in Patients with a Previous Cesarean Section

Yaser Abu –Ghazzeh, Rafic Barqawi

Prince Hashem Ibn Al Hussein Hospital, Royal Medical Services, Zarka, Jodrdan.

Objective: The objective of this study was to determine the impact of low–dose computed tomography (CT) pelvimetry in women with a previous cesarean section who fulfilled the criteria for vaginal birth after cesarean delivery.

Material and methods: A case–control study was conducted at the Department of Obstetrics and Gynecology, Prince Hashim Hospital, Zarka, Jordan, to determine the value of CT pelvimetry in patients with a previous cesarean section.

There were no differences in birth weights and Apgar scores between the two groups. There were no perinatal deaths in this study.

Conlusion: CT pelvimetry increased the rate of cesarean delivery without any benefit in the immediate delivery outcome. Therefore, the practice of documenting the adequacy of the pelvis by CT pelvimetry before vaginal birth after cesarean should be discouraged and should be reserved for clinically difficult or problematic cases.

Keywords: CT Pelvimetry, Cesarean section, Vaginal delivery.

HLA Class l Alleles Association and Seroreactivity to Common Bacterial and Thyroid Antigens in Iraqi Patients with Graves ‘ Disease

Faculty of Pharmacy and Medical Technology, The University of Petra, Amman, Jordan. Department of Immunology, The London Hospital Medical School, London, UK and Radioisotope Institute, Medical City Hospital, Baghdad, Iraq.

Objective: Graves’ disease is an autoimmune disease of unknown etiology. In certain populations, such as Caucasoids and Japanese, Graves’ disease was found to be associated with HLA-B8 and HLA-B35, respectively. Therefore, to investigate such relationship in Iraqi patients with Graves’ disease, the frequency of HLA class l antigens was evaluated. In addition, the hyperresponsiveness statuses to ubiquitous antigens and to thyroid antigens in Graves’ disease patients were examined.

Patients and Methods: Fifty–six Iraqi patients with Graves’ disease were examined for HLA class I antigens, antibodies to salmonella O, H, streptolysin O, thyroglobulin, and thyroid microsomal antigens and the results were compared to normal controls. For HLA association, p values were corrected by multiplying them by the number of HLA antigens which were typed for.

Results: A negative association was noticed between HLA- A29 and Graves’ disease patients (p<0.02) with a relative risk of 0.071 (95% confidence interval 0.045-0.15). In addition, a positive association was observed between HLA-A2 and Graves’ disease patients (p= 0.057) with a relative risk of 2.6 (95% confidence interval 0.8-8.7). Furthermore, the number of male patient responders to salmonella H antigens was significantly higher (p< 0.001) than female patients with Graves’ disease and also to normal male controls (p< 0.025). The number of responders and antibody titers of anti-thyroglobulin and anti-microsomal antibody in Graves’ disease patients were significantly higher (p<0.05-0.001) compared to normal controls.

Conclusion: A positive, but weak, association between HLA-A2 expression and Graves’ disease was observed in the Iraqi population. In addition, the presence of HLA –A29 may have a protective role against Graves’ disease in Iraq. Furthermore the absence of hyper responsiveness of Graves’ disease patients to common bacterial ubiquitous antigens may be due the organ specific nature of the disease.

Keywords: HAL class I antigens, Graves’ disease, Iraq, Thyroid antigens, Salmonella antibodies, Streptolysin O antibodies.

Are Magnetic Resonance Imaging or Computerized Tomography Required for Tension Headache?

Department of Radiology, King Hussein Medical Center, Amman, Jordan.

Abstract

To assess the value of Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) in tension headache, the clinical information and brain MRI and CT results of 200 patients (115 males and 85 females) who presented between June 1997 and April 1998 were reviewed. One hundred and fifty patients had a normal brain MRI, and 50 patients had clinically irrelevant findings (33 sinus disease, 5 mastoiditis, 11 ischaemic changes and one small falx meningioma). We conclude that brain imaging is seldom required in tension headache. A careful history and physical examination are more helpful and cost effective than brain imaging in the evaluation of headache.

Key words: Magnetic Resonance Imaging, Computerized Tomography, Tension headache.

Lacrimal Punctoplsty with Mitomycin C

Department of Ophthalmology, King Hussein Medical Center, Amman, Jordan.

Aim: To assess the effectiveness of the application of mitomycin C to the 3-snip procedure performed to relive lacrimal punctal stenosis.

Patients and Methods: 16 puncta of 9 patients (6 males, 3 females) with an age range of 44 to 70 hears, were treated and observed for a period of one to eight months. The 3-snip procedure was performed for the stenosed puncta and mitomycin was applied to the surgical field for 3 minutes. Fourteen puncta were fibrosed because of inflammatory and senile causes and two were fibrosed after longstanding exposure to chemical vapor.

Results: There was 100% objective and subjective improvement, without intra-or postoperative complications.

Conclusion: Application of mitomycin C increases the rate of surgical success of punctoplasty of stenosed lacrimal puncta.

Keywords: Lacrimal punctal stenosis, Punctoplasty, 3-snip procedure, Mitomycin C.

Analysis of 1340 Cases

Department of General Surgery, King Hussein Medical Center, Amman, Jordan.

Abstract

One postoperative death resulted from a non–surgical complication due to extensive myocardial infarction. These data demonstrate that laparoscopic cholecystectomy is associated with a low rate of morbidity and mortality, that do not outweigh the advantages of this minimally invasive surgery.

Keywords: Laparoscopic cholecystectomy, Complications.

Lactate Dehydrogenase Enzyme Activity in Cerebrospinal Fluid and Serum in Patients with Benign Intracranial Hypertension

Department of Neurosurgery, Jordan University Hospital, Amman, Jordan.

Object: The aim of this study was to determine the levels of lactate dehydrogenase (LDH) enzyme activity in the cerebral fluid (CSF) and serum in patients with benign intracranial hypertension (BIH) as a cellular metabolic marker for both diagnostic and prognostic purposes.

Methods: In this prospective study we selected 10 patients (8 women and 2 men with an age range between 22 to 58 years) from our patient population who were proven to have BIH and who had not responded to medical treatment. All these patients were managed surgically by lumboperitoneal shunt insertion. Measurement of intracranical pressure with CSF and serum measurement of total LDH activity were performed intraoperatively at the time of shunt insertion. The patients were followed up for 3 months using papilledema and headache as clinical markers. All patients had increased activity in total LDH enzyme activity in CSF and 8 (80%) had increased activity In serum.

Conclusion: Our study has shown a positive correlation between BIH and increased activity of LDH enzyme in the CSF. It is possible that this finding could be useful for the diagnosis and follow up of BIH.

Keywords: Benign intracranial hypertension, Cerebral brain perfusion, lactate dehydrogenase.

Clinical Patterns of Cerebral Palsy in 202 Jordanian patients

Department of Pediatrics, Jordan University Hospital, Amman, Jordan.

Abstract

Quadriparetic CP was the most common type accounting for 41% of CP cases which is different from the literature where diplegic CP was the most common. Associated conditions such as cognitive impairement and seizures occurred in 170 (84.1%) of CP cases. Ninety–two out of 167 (55.1%) patients above the age of 12 months at the time of data collection were able to walk. The severe form of CP was documented in 45 (22.2%) patients. The high incidence of associated conditions, CP patients who were unable to walk and the severe form CP are most likely due to the high incidence of quadriparetic CP in our study. That also reflects the level of neonatal and obstetric care. Brain CT was performed on 176 patients, and revealed abnormalities in 118 (67%). MRI scans were performed on 16 patients and revealed abnormalities in eight. To conclude, our results suggest that tertiary care centers deal mainly with the complicated CP cases which impose a lot of demand on services and also reflect the level of pediatric and obstetric care. More prospective studies are needed to evaluate the magnitude of the problem in Jordan.

Key words: Cerbral palsy, Jordan, Neuroimaging.

 Severe Upper Gastrointestinal Bleeding in a Healthy Full- Terms Neonate

Department of Pediatrics, King Hussein Medical Center, Amman, Jordan.

Abstract

A healthy full–term neonate developed massive upper gastrointestinal bleeding at four hours of life. The pregnancy and delivery had been uneventful. She was shown to have multiple gastro-esophageal ulceration by endoscopy and biopsy. The patient responded to conservative treatment and there was no recurrence during one year of follow up.

Mustafa M: Shennak Mazen Bdour

Tel: 9626 - 568 6616 / 5665620

Fax: 9626- 568 6435 

Subject: MedicsIndex - JMJ