Pre-operative Over-investigation of Routine Tests Prior to Elective Surgeries

Background: Previous studies stressed on the burden raised by routine pre-operative test ordering, which should be based on the assessment of patient physical status. In a tertiary hospital in Jordan, we aim to study the compliance with guidelines regarding pre-operative routine testing prior to an elective surgery, cholecystectomy, and calculate the estimated cost from non-compliance with the guidelines.Methods: We included laparoscopic cholecystectomy (through ICD-9 code) to represent an elective surgery. For each surgery done from the period 1/1/2016 to 31/12/2016, data regarding preoperative investigations, admission history note, operative and discharge note were obtained. Tests that are considered routine investigations are Complete blood count (CBC), kidney function tests (KFT), electrolytes, chest X-ray, electrocardiogram, coagulation studies, and urine-analysis. We classified patients who underwent cholecystectomy according to the latest version of the American Society of Anesthesiologists (ASA) physical status system to assess the need for routine tests, then we calculated the number and cost of excess tests.Results: A total 382 routine, non-emergent laparoscopic cholecystectomy surgeries were performed. 319 (83.5%) of patients were classified as ASA-1, 60 (15.7%) were classified as ASA-2, and only 3 (0.8%) were classified as ASA-3. Age was a significant determinant in obtaining chest X-ray ordering and findings (p< 0.001) and electrolytes ordering and findings (p= 0.001). Total routine tests cost for elective cholecystectomy during 2016 was 16,021$. Regarding operative compilations, only 14 (3.7%) complication occurred, all of which were bleeding related.Conclusion: Oversighting routine preoperative test ordering before elective cholecystectomy will significantly reduce the cost without increasing post-operative complications

Giant Spontaneous Femoral Artery Pseudoaneurysm Treated with Covered Stents : Report of a rare presentation and review of literature

We report the case of a 62-year-old woman who presented with a one-month history of a pulsatile mass, with no antecedent trauma or intervention. Imaging showed a large pseudoaneurysm (PSA) of the distal portion of the left superficial femoral artery. The PSA was treated successfully with endovascular placement of covered stents

The Frequency of Asymptomatic Sacroiliitis in Jordanian Patients with Crohn’s Disease. Assessment by Magnetic Resonance Enterography

Background: our aim was to assess frequency of asymptomatic sacroiliitis (SI) in patients with Crohns disease referred for magnetic resonant enterography (MRE) as a part of small bowel evaluation. Methods: this was a retrospective study of all patients with Crohns disease who were referred for MRE between January of 2016 to October of 2017 to Jordan University Hospital. All MRE were reviewed by an experienced radiologist and SI was diagnosed and graded based on predefined MRI criteria. All patients were contacted and assessed for symptomatic SI based on Assessment of SpondyloArthritis international Society (ASAS) criteria of 2009 for axial spondyloarthropathy. All patients were included in the final analysis.Results: a total of 60 patients were included, overall 18 (30%) showed evidence of SI, two patients were symptomatic and another two were diagnosed with ankylosing spondylitis as assessed by ASAS criteria. Those were excluded. Fourteen (23%) patients were included in the final analysis, with an average age of 36.7 years, 71% males. The average disease duration was 7.25 years. The percentage of ASA used by patients was 50%, Azathioprine 71%, Biologic agents in 36% in combination and single drug was used in 36% of patients.Conclusion: The prevalence of asymptomatic SI based on predefined MRI criteria was 23%, the importance of this finding and future course progression needs further studies

Correlation between clinical and magnetic resonance imaging (MRI) findings in temporomandibular disorders

This study was carried out to determine the value of Magnetic resonance imaging (MRI) as a diagnostic tool in patients with temporomandibular disorders. The clinical presentation and MRI findings on 88 temporomandibular joints belonging to 44 symptomatic patients were retrospectively studied. The disk position, configuration and signal intensity; mandibular condyle morphology and signal intensity; temporomandibular joint space and surrounding soft tissue abnormality were assessed. The correlation between the clinical and MRI findings was statistically analyzed using Fisher&apos;s exact (1-sided) test. Pain in the temporomandibular region was the most common clinical presentation, it accounts for 64% of cases. There was significant correlation between pain, and disc displacement with no reduction (DDWNR) and condylar hyperlaxity (p = 0.04, 0.03, respectively), as well as between clicking and each type of DD (p = 0.00). Statistically significant relationship was also found between tenderness, and DDWNR and presence of joint effusion (p = 0.02, 0.03, respectively) as well as between limitation of mouth opening and condylar marrow edema (p = 0.02). Causes of temporomandibular disorders can be well defined by clinical examination. However, MRI can be preserved for patients with pain in whom an initial medical conservative oral treatment failed in order to exclude other pathological process

Rupture of De Novo Middle Cerebral Artery Aneurysm 8 Years After the Clipping of Ruptured M1 Middle Cerebral Artery Aneurysm.

BACKGROUND Development and rupture of a de novo intracranial aneurysm is rare. Little is known regarding its etiology and the appropriate timing of follow-up angiograms after surgical clipping or coiling. CASE REPORT We present a case report of a 39-year-old male smoker with history of hypertension who developed a de novo aneurysm 8 years after surgical clipping of an aneurysm in the middle cerebral artery in the same segment. He presented with neck rigidity and drowsiness. Laboratory analysis did not show blood dyscrasia. Brain computerized tomography showed right temporal lobe hematoma and 4-vessel angiogram demonstrated de novo aneurysm in the same segment of the M1 middle cerebral artery, which was confirmed by intraoperative microsurgical findings. We review the literature on such cases and discuss the pathophysiology, diagnosis, and treatment of this condition. De novo aneurysm, although rare, can develop within days to as long as 10 years after surgical clipping or coiling. CONCLUSIONS This rare case of de novo aneurysm supports follow-up imaging of patients after initial surgical clipping for up to 10 years