Background: The present study is a prospective randomized double-blinded study that designed to e... more Background: The present study is a prospective randomized double-blinded study that designed to evaluate and compare the effectiveness of postoperative pain control and incidence of complications between ilioinguinal/iliohypogastric nerve block and intravenous morphine in paediatric patients undergoing unilateral orchidopexy in day surgery unit. Methods: Seventy patients aged 2-12 years were randomly allocated to two groups of thirty five. One group received intravenous morphine 100 microgram/kg before skin incision and the other group had ilioinguinal/iliohypogastric nerve block with 0.25 ml/kg bupivacaine 0.5% also before skin incision. All patients have received standardized anaesthesia. Postoperative pain was assessed using 0 - 10 scale at 0, 1, 2, 3 and 4 postoperative hours, also the intraoperative fentanyl requirements, time to first postoperative analgesia, the total number of paracetamol doses and any extra analgesic requirements were recorded, side effects like respiratory depression, vomiting, itching, inguinal hematoma and lower limb weakness were assessed during the first 24 hours. Results: Pain scores were significantly lower in the morphine group compared to the block group on admission and one hour after admission to the postanaesthesia care unit, no significant difference in pain score on 2nd, 3rd and 4th postoperative hours. The total number of intraoperative fentanyl doses was significantly higher in the block group compared to morphine group, there was no significant difference in the duration of analgesia, number of total paracetamol doses, need for extra analgesics in both groups over the 24 postoperative hours. None of the seventy patients experienced postoperative respiratory depression, inguinal hematoma or lower limb weakness, but significantly more patients in morphine group experienced vomiting and itching compared to the block group. Conclusion: Ilioinguinal/iliohypogastric nerve block and intravenous morphine administered following general anaesthesia for unilateral orchidopexy in day surgery unit are safe and effective in controlling postoperative pain, morphine analgesia had a higher incidence of postoperative vomiting and itching.
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy with a growing incide... more Differentiated thyroid cancer (DTC) is the most common endocrine malignancy with a growing incidence worldwide. The initial conventional management is surgery, followed by consideration of 131I treatment that includes three options. These are termed remnant ablation (targeting benign thyroid remnant), adjuvant (targeting presumed microscopic DTC) and known disease (targeting macroscopic DTC) treatments. Some experts mostly rely on clinicopathologic assessment for recurrence risk to select patients for the 131I treatment. Others, in addition, apply radioiodine imaging to guide their treatment planning, termed theranostics (aka theragnostics or radiotheragnostics). In patients with low‐risk DTC, remnant ablation rather than adjuvant treatment is generally recommended and, in this setting, the ATA recommends a low 131I activity. 131I adjuvant treatment is universally recommended in patients with high‐risk DTC (a primary tumor of any size with gross extrathyroidal extension) and is generally recommended in intermediate‐risk DTC (primary tumor >4 cm in diameter, locoregional metastases, microscopic extrathyroidal extension, aggressive histology or vascular invasion). The optimal amount of 131I activity for adjuvant treatment is controversial, but experts reached a consensus that the 131I activity should be greater than that for remnant ablation. The main obstacles to establishing timely evidence through randomized clinical trials for 131I therapy include years‐to‐decades delay in recurrence and low disease‐specific mortality. This mini‐review is intended to update oncologists on the most recent clinical, pathologic, laboratory and imaging variables, as well as on the current 131I therapy‐related definitions and management paradigms, which should optimally equip them for individualized patient guidance and treatment.
BACKGROUND The present study is a prospective randomized double-blinded study that designed to ev... more BACKGROUND The present study is a prospective randomized double-blinded study that designed to evaluate and compare the effectiveness of postoperative pain control and incidence of complications between ilioinguinal/iliohypogastric nerve block and intravenous morphine in paediatric patients undergoing unilateral orchidopexy in day surgery unit. METHODS Seventy patients aged 2-12 years were randomly allocated to two groups of thirty five. One group received intravenous morphine 100 microgram/kg before skin incision and the other group had ilioinguinal/iliohypogastric nerve block with 0.25 ml/kg bupivacaine 0.5% also before skin incision. All patients have received standardized anaesthesia. Postoperative pain was assessed using 0 - 10 scale at 0, 1, 2, 3 and 4 postoperative hours, also the intraoperative fentanyl requirements, time to first postoperative analgesia, the total number of paracetamol doses and any extra analgesic requirements were recorded, side effects like respiratory d...
The 2015 American Thyroid Association (ATA) guidelines called for significantly more selective 13... more The 2015 American Thyroid Association (ATA) guidelines called for significantly more selective 131I therapy in patients with low-risk differentiated thyroid cancer (DTC). We hypothesized that application of these guidelines would significantly reduce the 131I activity utilized by an academic tertiary hospital in Jordan. All DTC patients managed at Jordan University Hospital (JUH) between 1/2009 and 6/2019 were classified according to the 2015 ATA risk category and 131I activity was assigned accordingly. The actual 131I activity administered was compared with that recommended by the 2015 ATA guidelines. In total, 135/182 DTC patients (74.2%) managed at JUH underwent 131I therapy. Of those, 58 (43%) had ATA low-, 58 (43%) intermediate-, and 19 (14%) high-risk disease. The low-, intermediate-, and high-risk DTC patients received an average (±SD) initial 131I activity of 3.53 ± 0.95, 4.40 ± 1.49, and 5.06 ± 2.52 GBq, respectively. Withholding 131I therapy altogether in the 2015 ATA low-...
ABSTRACT This study reviewed all the data about cases which were diagnosed as carotid body paraga... more ABSTRACT This study reviewed all the data about cases which were diagnosed as carotid body paraganglioma (CBP) at Jordan University Hospital, from January 2003 till December 2007. The management and outcome were discussed. Nine cases diagnosed as CBP, with an average age of 44.2 years, painless neck mass was the presentation of 8 patients, there were 5 patients with tumor size equal or more than 5cm. All of them had CT scan for diagnosis. Angiogram with embolization was done for 5 patients, All patients underwent surgical excision without mortality; the carotid arteries were intact except in two cases where the external carotid arteries were ligated. There was palsy to hypoglossal and/or vagus nerves in 5 patients which improved in 2 of them. No recurrence of tumor was seen. In conclusion; surgical excision is the treatment of choice for CBP, and it should be performed early in order to avoid progressive local invasion and decrease the rate of morbidity.
Medical Journal of the Islamic Republic of Iran, 2020
This report is to describe a rare case of parotid metastasis from renal cell carcinoma (RCC) in a... more This report is to describe a rare case of parotid metastasis from renal cell carcinoma (RCC) in a50- year- old male presenting with unilateral facial symptoms. Following investigations, the patient was diagnosed to have metastatic renal cell carcinoma. He was planned for radio-chemotherapy, and got deceased 1 year afterward.
International Journal of Human and Health Sciences (IJHHS)
Objective: B-type Raf kinase (BRAF)V600E mutation in papillary thyroid cancer (PTC) has variable ... more Objective: B-type Raf kinase (BRAF)V600E mutation in papillary thyroid cancer (PTC) has variable prevalence worldwide and it is hypothesized to worsen tumor prognosis. This study was conducted to investigate the prevalence of BRAFV600E mutation among PTC patients and to find out its prognostic impact measured by its association with various clinicopathologic features, recurrence, and mortality.Methods: This is a retrospective study that included 123 PTC patients who underwent thyroidectomy at Jordan University Hospital between January 2010 and December 2015. They were followed up over a mean of 18 months (range: 4-72). BRAFV600E mutation was analyzed by direct sequencing. A p value less than 0.05 was defined as statistically significant.Results: Twenty three out of 123 (18.7%) PTC patients were BRAFV600E mutation positive. BRAFV600E- mutant patients were more likely to have larger tumor size (1.8 vs 2.5 cm, p=0.040), to present with lymph node metastasis (LNM) (41.2% vs 82.4%, p=0.0...
To report rates of and reasons for operation cancellation, and to prioritize areas of improvement... more To report rates of and reasons for operation cancellation, and to prioritize areas of improvement. Retrospective data were extracted from the monthly reports of cancelled listed operations. Data on 14 theatres were collected by the office of quality assurance at Jordan University Hospital from August 2012 to April 2016. Rates and reasons for operation cancellation were investigated. A Pareto chart was constructed to identify the reasons of highest priority. During the period of study, 6,431 cases (9.31%) were cancelled out of 69,066 listed cases. Patient no-shows accounted for 62.52% of cancellations. A Pareto analysis showed that around 80% of the known reasons for cancellation after admission were due to a lack of surgical theatre time (30%), incomplete preoperative assessment (21%), upper respiratory tract infection (19%), and high blood pressure (13%). This study identified the most common reasons for operation cancellation at a teaching hospital. Potential avoidable root causes...
Background: The present study is a prospective randomized double-blinded study that designed to e... more Background: The present study is a prospective randomized double-blinded study that designed to evaluate and compare the effectiveness of postoperative pain control and incidence of complications between ilioinguinal/iliohypogastric nerve block and intravenous morphine in paediatric patients undergoing unilateral orchidopexy in day surgery unit. Methods: Seventy patients aged 2-12 years were randomly allocated to two groups of thirty five. One group received intravenous morphine 100 microgram/kg before skin incision and the other group had ilioinguinal/iliohypogastric nerve block with 0.25 ml/kg bupivacaine 0.5% also before skin incision. All patients have received standardized anaesthesia. Postoperative pain was assessed using 0 - 10 scale at 0, 1, 2, 3 and 4 postoperative hours, also the intraoperative fentanyl requirements, time to first postoperative analgesia, the total number of paracetamol doses and any extra analgesic requirements were recorded, side effects like respiratory depression, vomiting, itching, inguinal hematoma and lower limb weakness were assessed during the first 24 hours. Results: Pain scores were significantly lower in the morphine group compared to the block group on admission and one hour after admission to the postanaesthesia care unit, no significant difference in pain score on 2nd, 3rd and 4th postoperative hours. The total number of intraoperative fentanyl doses was significantly higher in the block group compared to morphine group, there was no significant difference in the duration of analgesia, number of total paracetamol doses, need for extra analgesics in both groups over the 24 postoperative hours. None of the seventy patients experienced postoperative respiratory depression, inguinal hematoma or lower limb weakness, but significantly more patients in morphine group experienced vomiting and itching compared to the block group. Conclusion: Ilioinguinal/iliohypogastric nerve block and intravenous morphine administered following general anaesthesia for unilateral orchidopexy in day surgery unit are safe and effective in controlling postoperative pain, morphine analgesia had a higher incidence of postoperative vomiting and itching.
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy with a growing incide... more Differentiated thyroid cancer (DTC) is the most common endocrine malignancy with a growing incidence worldwide. The initial conventional management is surgery, followed by consideration of 131I treatment that includes three options. These are termed remnant ablation (targeting benign thyroid remnant), adjuvant (targeting presumed microscopic DTC) and known disease (targeting macroscopic DTC) treatments. Some experts mostly rely on clinicopathologic assessment for recurrence risk to select patients for the 131I treatment. Others, in addition, apply radioiodine imaging to guide their treatment planning, termed theranostics (aka theragnostics or radiotheragnostics). In patients with low‐risk DTC, remnant ablation rather than adjuvant treatment is generally recommended and, in this setting, the ATA recommends a low 131I activity. 131I adjuvant treatment is universally recommended in patients with high‐risk DTC (a primary tumor of any size with gross extrathyroidal extension) and is generally recommended in intermediate‐risk DTC (primary tumor >4 cm in diameter, locoregional metastases, microscopic extrathyroidal extension, aggressive histology or vascular invasion). The optimal amount of 131I activity for adjuvant treatment is controversial, but experts reached a consensus that the 131I activity should be greater than that for remnant ablation. The main obstacles to establishing timely evidence through randomized clinical trials for 131I therapy include years‐to‐decades delay in recurrence and low disease‐specific mortality. This mini‐review is intended to update oncologists on the most recent clinical, pathologic, laboratory and imaging variables, as well as on the current 131I therapy‐related definitions and management paradigms, which should optimally equip them for individualized patient guidance and treatment.
BACKGROUND The present study is a prospective randomized double-blinded study that designed to ev... more BACKGROUND The present study is a prospective randomized double-blinded study that designed to evaluate and compare the effectiveness of postoperative pain control and incidence of complications between ilioinguinal/iliohypogastric nerve block and intravenous morphine in paediatric patients undergoing unilateral orchidopexy in day surgery unit. METHODS Seventy patients aged 2-12 years were randomly allocated to two groups of thirty five. One group received intravenous morphine 100 microgram/kg before skin incision and the other group had ilioinguinal/iliohypogastric nerve block with 0.25 ml/kg bupivacaine 0.5% also before skin incision. All patients have received standardized anaesthesia. Postoperative pain was assessed using 0 - 10 scale at 0, 1, 2, 3 and 4 postoperative hours, also the intraoperative fentanyl requirements, time to first postoperative analgesia, the total number of paracetamol doses and any extra analgesic requirements were recorded, side effects like respiratory d...
The 2015 American Thyroid Association (ATA) guidelines called for significantly more selective 13... more The 2015 American Thyroid Association (ATA) guidelines called for significantly more selective 131I therapy in patients with low-risk differentiated thyroid cancer (DTC). We hypothesized that application of these guidelines would significantly reduce the 131I activity utilized by an academic tertiary hospital in Jordan. All DTC patients managed at Jordan University Hospital (JUH) between 1/2009 and 6/2019 were classified according to the 2015 ATA risk category and 131I activity was assigned accordingly. The actual 131I activity administered was compared with that recommended by the 2015 ATA guidelines. In total, 135/182 DTC patients (74.2%) managed at JUH underwent 131I therapy. Of those, 58 (43%) had ATA low-, 58 (43%) intermediate-, and 19 (14%) high-risk disease. The low-, intermediate-, and high-risk DTC patients received an average (±SD) initial 131I activity of 3.53 ± 0.95, 4.40 ± 1.49, and 5.06 ± 2.52 GBq, respectively. Withholding 131I therapy altogether in the 2015 ATA low-...
ABSTRACT This study reviewed all the data about cases which were diagnosed as carotid body paraga... more ABSTRACT This study reviewed all the data about cases which were diagnosed as carotid body paraganglioma (CBP) at Jordan University Hospital, from January 2003 till December 2007. The management and outcome were discussed. Nine cases diagnosed as CBP, with an average age of 44.2 years, painless neck mass was the presentation of 8 patients, there were 5 patients with tumor size equal or more than 5cm. All of them had CT scan for diagnosis. Angiogram with embolization was done for 5 patients, All patients underwent surgical excision without mortality; the carotid arteries were intact except in two cases where the external carotid arteries were ligated. There was palsy to hypoglossal and/or vagus nerves in 5 patients which improved in 2 of them. No recurrence of tumor was seen. In conclusion; surgical excision is the treatment of choice for CBP, and it should be performed early in order to avoid progressive local invasion and decrease the rate of morbidity.
Medical Journal of the Islamic Republic of Iran, 2020
This report is to describe a rare case of parotid metastasis from renal cell carcinoma (RCC) in a... more This report is to describe a rare case of parotid metastasis from renal cell carcinoma (RCC) in a50- year- old male presenting with unilateral facial symptoms. Following investigations, the patient was diagnosed to have metastatic renal cell carcinoma. He was planned for radio-chemotherapy, and got deceased 1 year afterward.
International Journal of Human and Health Sciences (IJHHS)
Objective: B-type Raf kinase (BRAF)V600E mutation in papillary thyroid cancer (PTC) has variable ... more Objective: B-type Raf kinase (BRAF)V600E mutation in papillary thyroid cancer (PTC) has variable prevalence worldwide and it is hypothesized to worsen tumor prognosis. This study was conducted to investigate the prevalence of BRAFV600E mutation among PTC patients and to find out its prognostic impact measured by its association with various clinicopathologic features, recurrence, and mortality.Methods: This is a retrospective study that included 123 PTC patients who underwent thyroidectomy at Jordan University Hospital between January 2010 and December 2015. They were followed up over a mean of 18 months (range: 4-72). BRAFV600E mutation was analyzed by direct sequencing. A p value less than 0.05 was defined as statistically significant.Results: Twenty three out of 123 (18.7%) PTC patients were BRAFV600E mutation positive. BRAFV600E- mutant patients were more likely to have larger tumor size (1.8 vs 2.5 cm, p=0.040), to present with lymph node metastasis (LNM) (41.2% vs 82.4%, p=0.0...
To report rates of and reasons for operation cancellation, and to prioritize areas of improvement... more To report rates of and reasons for operation cancellation, and to prioritize areas of improvement. Retrospective data were extracted from the monthly reports of cancelled listed operations. Data on 14 theatres were collected by the office of quality assurance at Jordan University Hospital from August 2012 to April 2016. Rates and reasons for operation cancellation were investigated. A Pareto chart was constructed to identify the reasons of highest priority. During the period of study, 6,431 cases (9.31%) were cancelled out of 69,066 listed cases. Patient no-shows accounted for 62.52% of cancellations. A Pareto analysis showed that around 80% of the known reasons for cancellation after admission were due to a lack of surgical theatre time (30%), incomplete preoperative assessment (21%), upper respiratory tract infection (19%), and high blood pressure (13%). This study identified the most common reasons for operation cancellation at a teaching hospital. Potential avoidable root causes...
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Papers by Nader Albsoul