Kidney Biopsy in Jordan: Complications and Histopathological Findings

In this retrospective study, we reviewed the medical records, and histopathology findings of 191 patients who underwent renal biopsies at King Hussein Medical Center (KHMC) during a four-year period (1993-97). All were performed using Tru-Cut needles under ultrasound guidance. There were 119 males (62.3%) and 72 females (37.7%); the mean age was 29.1 years (range 5-76 years). Side effects of the renal biopsies included pain at the site of he biopsy in 17 (8.9%), gross hematuria in six (3.1%) and hematuria requiring blood transfusion in one (0.5%) patient. Nephrotic syndrome was the most common indication for biopsy followed by acute renal failure of unknown etiology. Among the nephritic patients, minimal change disease and post-infectious glomerulonephritis (GN) were the commonest findings in children below the age of 15 years, membrano-proliferative GN ranked first in adults whole membranous GN and amyloidosis were more common in the elderly. WE conclude that renal biopsy was associated with a n acceptably low rate of complications in our practice, and that the patterns of renal histology vary slightly from those reported from other countries

Functional Status of Patients on Maintenance Hemodialysis

Factors associated with physical well being were examined in adults with end-stage renal disease (ESRD) in two large hemodialysis units of the Royal Medical Services in Jordan. Utilizing the Karnofski scale we measured the functional status of 200 Patients who had been on maintenance hemodialysis for at least 12 months. A Marnofski scale of less than 70 incidents frank disability (Inability to perform routine living activities without assistance), in addition current vocational status was assessed as well as any existing comorbid conditions. The mean age of the study group was 45.2 years (range 16 to 70) and included 108 (54%) males and 92 (46%) females, there were 39 (19.5%) diabetic patients and 27 (13.5%) patients were receiving erythropoietin (EPO). The mean hematocrit of the entire group was 27.8%. As measured by Karnofski scale, 64 (32%) of the patients were unable to perform routine living activity without assistance; dependence on wheelchair was reported by 9 (4.5%) patients. The mean comorbidity index of patients who scored less than 70 on the Karnofski scale was 1.5 compared to 0.7 for those who scored at least 70 on the same scale (p< 0.001). Analysis of factors showed that age and diabetes mellitus affected functional status. Of the laboratory variables measured, only serum albumin concentration correlated significant with Karnofski scale. Fourteen (21.8%) of the patients who scored below 70, had serum albumin concentration above 40g/L compared to 66 (48.5%) of the patients who scored at least 70 on the Karnofski scale (p< 0.001). We conclude that a significant proportion of patients on maintenance hemodialysis is functionally disabled. The elderly, diabetics, patients with high co-morbidity index and those with low serum albumin are most likely to have poor functional status

Contemporary Approaches to the Surgical Management of Pancreatic Neuroendocrine Tumors

The incidence of pancreatic neuroendocrine tumors (PNETs) is on the rise primarily due to the increasing use of cross-sectional imaging. Most of these incidentally detected lesions are non-functional PNETs with a small proportion of lesions being hormone-secreting, functional neoplasms. With recent advances in surgical approaches and systemic therapies, the management of PNETs have undergone a paradigm shift towards a more individualized approach. In this manuscript, we review the histologic classification and diagnostic approaches to both functional and non-functional PNETs. Additionally, we detail multidisciplinary approaches and surgical considerations tailored to the tumor’s biology, location, and functionality based on recent evidence. We also discuss the complexities of metastatic disease, exploring liver-directed therapies and the evolving landscape of minimally invasive surgical techniques