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Nidal A Younes

Publications and source records attributed to Nidal A Younes.

14 recordsLinked to original sources
PubMed2006

New trends in the clinicopathological features of differentiated thyroid cancer in Central Jordan.

OBJECTIVE: To investigate the current trends in presentation and distribution of differentiated thyroid cancer (DTC) at the largest referral hospital for endocrine cancers in Central Jordan. METHODS: We analyzed the clinical features, management and outcome of 110 patients diagnosed with thyroid carcinoma at Jordan University Hospital, Amman, between 1996 and 2001. RESULTS: Papillary carcinoma was diagnosed in 87 patients (80%), follicular carcinoma in 3 patients (2.7%), Hurthle cell carcinoma in 8 patients (7.3%), medullary carcinoma in 5 (4.5%), and anaplastic carcinoma in 4 patients (3.6%), metastatic cancer in 2 patients and lymphoma in one patient. Time course analysis showed an increasing trend in surgery for thyroid cancer from 28 cases in 1986-1991 to 48 in 1996-2001. As time advanced, the incidence of locally invasive disease and lymph node involvement markedly increased over the last 5 years of the study (from 28-62%). All patients with follicular carcinoma were diagnosed in the period 1986-1994. After thyroidectomy and a follow up period of 2-15 years, 10 patients died of their disease, 4 of these died within one year from anaplastic thyroid carcinoma. CONCLUSION: The dramatic decline in the incidence of follicular thyroid carcinoma combined with the increase in the advanced forms of thyroid cancer in Central Jordan may suggest a possible environmental factor in thyroid carcinogenesis in this region. We suggest a larger scale studies and steps to investigate the etiologic factors for thyroid carcinogenesis in Central Jordan.

Adult↗
PubMed2006

Diabetic foot infection.

Diabetic foot infection DFI is simply defined as suspected or documented infection of the tissues that comprise the foot of a diabetic patient. Diabetic foot infection is often caused by introduction of an infection into the otherwise sterile soft tissues of the foot through a minor skin break down. Diabetic foot infection may be mild usually restricted to the uppermost layers of the skin, moderate extending down to the soft tissues of the foot or severe infection associated with systemic toxicity or metabolic instability. The paper reviews the types of DFI, pathophysiology, microbiology of DFI, relevant anatomy of the foot, clinical evaluation, measures of severity of DFI, the role of radiological investigations, and the role of early surgical intervention in the prevention of progressive foot infection and limb salvage. It is concluded that the diagnosis of DFI should be suspected at an early stage based on the presence of local signs of inflammation with or without systemic signs of toxicity or metabolic instability. Optimal treatment of DFI requires a multimodality approach directed at controlling hyperglycemia, administration of systemic antibiotics, and local wound management to prevent the spread and dissemination of infection.

Arterial Occlusive Diseases↗
PubMed2006

The spectrum of bone disease in Jordanian hemodialysis patients.

OBJECTIVE: To evaluate the spectrum of mineral abnormalities and bone disease (BD) in hemodialysis patients at Jordan University Hospital (JUH), Amman, Jordan. METHODS: A cross-sectional study was conducted among 63 patients (38 males and 25 females), mean age 44.19 years (range 17-76 years), with chronic kidney disease (CKD) on regular hemodialysis at JUH between November 2004 and April 2005. All patients have undergone complete blood count, chemistry profile, alkaline phosphatase, serum albumin, intact parathyroid hormone (iPTH) and plain x-rays. RESULTS: Bone disorders were identified in 45 patients on x-rays (70%). Osteopenia was found in 43 patients (68.3%), subperiosteal resorption in 24 patients (38.3%) and metastatic calcification in 22 patients (35%). Hypocalcemia was found in 28.6% and hypercalcemia in 7.9%. All patients were taking calcium carbonate, and 55.5% of patients were on vitamin D supplements. The calcium levels in 63.5% and the phosphorus levels in 50.8% of patients were within the recommended guidelines of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI). Serum i-PTH level was above 300 pg/ml high turnover bone disease in 24.6% of patients, 21.3% had iPTH of 150-300 pg/ml target, and 44.3% had i-PTH levels below 100 pg/mL suggesting a dynamic bone disease. Patients with severe bone disease had a statistically significant higher iPTH levels (p<0.005). CONCLUSION: Bone disease and mineral abnormalities are common in hemodialysis patients at JUH. Earlier detection of bone disease and better overall management strategy may reduce the frequency and severity of bone disease in CKD patients in Jordan.

Adolescent↗
PubMed2006

Topical phenytoin ointment increases autograft acceptance in rats.

OBJECTIVE: To examine the effectiveness of topical phenytoin in preserving the skin viability and increasing acceptance rate of autograft. METHODS: We conducted this study in the Central Laboratory Animal House of Jordan University of Science and Technology, Irbid, Jordan during the period from September 2004 to June 2005. Forty-two rats were divided into 2 equal groups; full thickness dorsal skin wound (4 cm2) was created in the rats. Twenty-one rats were treated with phenytoin (10% w/w ointment), the other 21 (control) were treated with standard dressing and Vaseline. An autograft was performed one week after treatment. Rats were examined for the presence of healthy granulation tissue, reduction in wound surface dimensions, and time for complete graft attachment. RESULTS: Phenytoin ointment had significantly increased wound bed viability and the rate of graft acceptance (p-value <0.0001). Twenty rats had successful grafting (10% phenytoin); while only 3 rats out of the 21 control had successful grafts. The mean time to complete graft attachment and hair growth in the grafted skin was 6.6 +/- 0.5 days. The mean wound contraction measurements (taken just before grafting) were as follow: control group 59.2 +/- 11.6%, and phenytoin group 55.7 +/- 9.2, difference in skin contractility was not statistically significant. Skin viability was evident by increased vascularity and granular tissue formation at the edges of the wound. CONCLUSION: Phenytoin appears to be an effective method for enhancing the take of the full-thickness skin graft. Further clinical use and evaluation of topical phenytoin ointment in skin grafting are merited.

Animals↗
PubMed2005

Laboratory screening for hyperparathyroidism.

INTRODUCTION: The clinical syndrome produced by excess parathyroid hormone (PTH) is referred to as hyperparathyroidism (HPT). Autonomous growth of PTH producing cells is defined as primary hyperparathyroidism (pHPT). In its classic form pHPT is characterized by painful bones, kidney stones, abdominal groans, psychic moans, fatigue overtones and hypercalcemia. Chronic stimulation of the parathyroid glands secondary to low circulating calcium level results in secondary hyperparathyroidism (sHPT). Tertiary hyperparathyroidism (tHPT) results from prolonged secondary hyperparathyroidism when the glands take on an autonomous function manifested by hypercalcemia and high PTH levels despite resolution of the original stimulus. REVIEW: The paper reviews the physiologic regulation of PTH secretion and types and forms of HPT. Calcium homeostasis is discussed, emphasizing interactions of PTH, PO4 and vitamin D that can lead to HPT. In addition, the paper reviews the contribution of serum calcium, chloride, phosphorus and PTH levels to the diagnosis of HPT, the role of urinary calcium in the diagnosis of familial benign hypocalciuric hypercalcemia (FBHH), and the role of alkaline phosphatase and bone mass measurements as markers of severity of hyperparathyroid bone disease. CONCLUSIONS: It is concluded that the diagnosis of hyperparathyroidism can be made with a very high confidence rate by documenting an increased serum PTH level with an increased ionized or total calcium level in pHPT, increased serum PTH level with low or normal calcium level and an underlying renal failure or vitamin D deficiency in sHPT. Early management of HPT is important because many of the nonspecific complains, or classic symptoms, or metabolic conditions often improve after proper control of hyperparathyroidism.

Calcitonin↗
PubMed2005

An unusual association between splenectomy and Kikuchi's disease.

Kikuchi's disease is a clinico-pathologic entity of unknown etiology characterized by subacute inflammatory process of lymph nodes. It affects mostly women around the age of 30 years. It is usually a self limiting illness characterized by pyrexia, neutropenia, and cervical lymphadenopathy. We report a case of Kikuchi's disease in a patient with past history of splenectomy. A 35-year-old otherwise healthy female patient presented with 15 days history of fever, night sweats, and right cervical lymphadenopathy. She was on no medication and had no contact with animals or patients with tuberculosis. Her past history revealed splenectomy for thrombocytopenia 14 years before presentation. Lymphoma was suspected and she was referred for a cervical lymph node biopsy. The final histopathology diagnosis revealed subacute necrotizing lymphadenitis consistent with Kikuchi's disease. This is the first case of Kikuchi's disease presenting in a post splenectomy patient.

Adult↗
PubMed2004

Diabetic heel ulcers: a major risk factor for lower extremity amputation.

Of all the ulcers seen in patients with diabetes, heel ulcers are the most serious and often lead to below-the-knee amputation. Management of heel ulcers requires a thorough knowledge of the major risk factors for ulceration in the heel area and a standardized program of local ulcer care, metabolic control, early control of infection, and improvement of blood supply to the foot. The most common risk factors for ulceration in the heel region include immobility of the lower limbs, diabetic neuropathy, structural deformity, and peripheral arterial occlusive disease. Patient education regarding foot hygiene, skin care, and proper footwear is crucial to reducing the risk of an injury that can lead to heel ulceration. A careful foot examination that tests for neuropathy and arterial insufficiency can identify patients at risk for heel ulcers and appropriately classify patients with ulcers into different grades to design proper therapeutic plans for management. Team management programs that focus on education, prevention, regular foot examinations, aggressive intervention, and proper use of therapeutic measures can significantly reduce the risk of lower-extremity amputations from heel ulcers.

Amputation, Surgical↗
PubMed2004

Brown tumor of the femur associated with double parathyroid adenomas.

Severe parathyroid bone disease is a rare clinical presentation of primary hyperparathyroidism. Double parathyroid adenomas are even more rare cause of primary hyperparathyroidism. The authors present a case of double parathyroid adenomas in a 48-year-old man, who presented with painful left lower limb swelling, which was slowly growing in size in the last 20 years. Magnetic resonance imaging revealed a cystic bony lesion and coincidentally, a urinary bladder calculus. Biopsy of the mass revealed giant cell lesion. Laboratory investigations showed hypercalcemia and hypophosphatemia with elevated parathyroid hormone level. A computerized tomography scan of the neck delineated an adenoma of the left superior parathyroid gland, which was surgically removed. The left inferior parathyroid was also enlarged and was removed. Histological diagnosis confirmed double parathyroid adenomas. The rarity and the interesting clinical presentation of such association are discussed.

Adenoma↗
PubMed2003

Clinical spectrum of primary hyperparathyroidism.

OBJECTIVE: Primary hyperparathyroidism (1HPT) is now being diagnosed with increasing frequency. Simultaneously there has been an apparent change in the presentation of the disease and indications for surgery. The aim of this study was to examine the clinical presentation, indications for surgery, and outcomes of neck explorations for primary hyperparathyroidism. METHODS: This study was carried out over a 12 year period, January 1990 to April 2002 at Jordan University Hospital, Amman, Jordan. Information on the indications, procedure performed, pathology and complications of all neck explorations for 1HPT was obtained from a retrospective thyroid/parathyroid surgical database. A minimum of 12 months follow-up was required in order to determine outcome of surgery. RESULTS: Out of 40 patients diagnosed with primary hyperparathyroidism at Jordan University Hospital, Amman, over 12 years, 14 patients (35%) diagnosed 4 years after the onset of their disease. Severe bone disease was the main indication for surgery in 28 patients; 5 patients with fractured bones, 2 patients with bone cysts, 3 patients with brown tumors and severe osteoporosis and backache in 22 patients; renal calculi in 10 patients; muscle ache and weakness in 14 patients; acute pancreatitis in one patient and asymptomatic HPT following biochemical screening in one patient. Two patients continued to have persistent hypercalcemia after the first operation; one of them has been cured by reoperation for an ectopic parathyroid in the anterior mediastinum resulting in an overall cure rate of 97.5%. CONCLUSION: This study showed that severe bone disease with fractures, bone cysts and brown tumors are still the most common presentation of primary hyperparathyroidism in Jordan; this is most likely due to delay in diagnosis and initiation of treatment. It is important to screen for hyperparathyroidism in high risk patients and to refer these patients to specialized centers for proper management.

Acute Disease↗
PubMed2003

Surgery versus pharmacotherapy of benign thyroid diseases.

Surgical management of benign thyroid diseases (BTDs) has been a topic of interest and confusion for many years. Almost 80% of thyroidectomies at an average endocrine surgical unit are carried out for BTDs. Resistance to surgical intervention in BTDs has been based on the belief that increased complication rate is inherent in its use, this is despite the potential advantages in terms of confirming the benign nature of the lesion, controlling the disease, and relieving local symptoms of large neck mass. Benign thyroid diseases are more likely to occur in middle-aged women living in iodine deficient areas, or have a family history of goiter, or in patients taking iodine-containing drugs, like amoidarone, or in patients with previous history of x-ray exposure. However, the physician must be careful in making the diagnosis of BTDs in patients at the extremes of age or in the presence of positive history of radiation, or in patients with family history of thyroid or colon cancer. In this article we will review the etiology, epidemiology, diagnostic methodologies and the recent trends in the surgical and medical management of BTDs.

Goiter, Nodular↗
PubMed2002

The cricothyroid space: a guide for successful thyroidectomy.

OBJECTIVE: The frequent complications of thyroid surgery are mostly related to the anatomy of the region. This stimulated us to look for a starting point that makes exploration of the region easier and consequently reduces complications. We aimed to explore and define the anatomy of the cricothyroid [CT] region from cadaveric dissection and to present the outcome of 73 consecutive thyroidectomies starting from a space in the CT region. METHODS: Dissection in the thyroid gland region and creating a space in the CT region was performed on five cadavers [10 spaces], followed by 73 consecutive thyroidectomies through a standard approach beginning from the CT space. RESULTS: In all cadavers, a space was easily created in the CT region. Vessels, nerves and the parathyroid glands were identified. Standard thyroidectomy starting from the CT space was performed on 73 patients. The external laryngeal nerve was seen in 40% of the cases. The recurrent laryngeal nerve was identified and preserved in all patients. Six patients had temporary hypocalcaemia and eight had a temporary voice change. None of the patients had permanent hypoparathyroidism or recurrent laryngeal nerve palsy. CONCLUSION: The CT space is an avascular space medial to the thyroid lobe and is a good starting point for thyroidectomy that allows easy and safe exploration of the region.

Adult↗
PubMedDate not supplied

The DEPA scoring system and its correlation with the healing rate of diabetic foot ulcers.

The purpose of this study was to examine the validity of a new scoring system in predicting the outcome of diabetic foot ulcers. The scoring system (DEPA score) includes the depth of the ulcer (D), the extent of bacterial colonization (E), the phase of ulcer healing (P) and the associated underlying etiology (A). The scoring system was validated against the clinical outcome in terms of healing and lower-limb amputations. Eighty-four patients were included in the study: 32 patients had a DEPA score of < or =6, 34 patients had a DEPA score of 7 to 9, and 18 patients had a DEPA score of > or =10. Using the Spearman nonparametric correlation test, DEPA scoring system was accurate in predicting the outcome of management (correlation coefficient, 0.78; 95% confidence interval, 0.68 to 0.86; P <.0001) at a mean follow-up of 20 weeks. The correlation was further validated by using a linear regression model (r = 0.85; slope best-fit value, 0.51; 95% confidence interval, 0.41 to 0.59; P <.0001). All patients with DEPA scores < or =6 had excellent healing, whereas only 15% of those with a score of > or =10 had complete healing in <20 weeks. In conclusion, an increasing DEPA score is associated with increased risk of amputation and poor healing. Furthermore, inclusion of the phase of ulcer healing into the DEPA system increases the accuracy of predicting the outcome of diabetic foot ulcers.

Adult↗
PubMedDate not supplied

Diabetic foot disease.

OBJECTIVE: To review the spectrum of foot problems in patients with diabetes and the underlying etiologic factors. METHODS: In this review, the term "diabetic foot disease" (DFD) will be used (previously referred to as simply "diabetic foot"). The relevant anatomy of the foot is discussed, the clinical evaluation and severity of DFD are outlined, and the role of both systemic control and local measures in the management of DFD is addressed. RESULTS: DFD is linked with a wide variety of etiologic associations, pathologic forms, and clinical severity. The causes of DFD include such factors as diabetic neuropathy, vascular insufficiency, and the presence of underlying bone deformity. The pathologic forms range from superficial skin lesions, soft tissue infections, joint swellings, and deformities to frank necrosis and gangrene. The clinical severity ranges from mild, self-resolving disease to fulminant, rapidly progressive disease that usually eventuates in amputation. The heterogeneity of patients whose illness is grouped collectively under the diagnosis of DFD has contributed to the persisting confusion and controversy regarding the optimal classification system for diabetes-related foot problems and their appropriate management. CONCLUSION: Optimal management of DFD involves a multimodality approach directed at regular foot care, blood glucose control, and early recognition of foot problems. Appropriate surgical management, administration of systemic antibiotics, and off-loading techniques are necessary to prevent the progression of DFD.

Coronary Disease↗