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This is a retrospective study designed to find out the clinical profile of children with Wilms′ tumor admitted to King Hussein Medical Center over a 6.5-year period. There were 26 patients (eight males and 18 females) with a median age of three years (range 1-8 years), at the time of diagnosis. Twenty children went into complete remission for a period ranging from 4-80 months (mean 46 months). Six children relapsed locally or with distant metastasis. All the six children with relapse died because of progressive disease. The overall relapse free survival was 77% for all stages (100%, 90%, 66.6%, 0% and 100% for stage I, II, III, IV and V respectively). This is similar to the international figures for stage I & II but is still behind for stage III & IV.

Background Certain echocardiographic parameters may serve as early predictors of adverse events in patients with hemodynamically compromising pulmonary embolism (PE). Methods and Results An observational analysis was conducted for patients with acute pulmonary embolism evaluated by a Pulmonary Embolism Response Team (PERT) between 2014 and 2020. The performance of clinical prediction algorithms including the Pulmonary Embolism Severity Index and Carl Bova score were compared using a ratio of right ventricle and left ventricle hemodynamics by dividing the pulmonary artery systolic pressure by the left ventricle stroke volume. The primary outcome of in-hospital mortality, cardiac arrest, and the need for advanced therapies was evaluated by univariate and multivariable analyses. Of the 343 patients meeting the inclusion criteria, 215 had complete data. Pulmonary artery systolic pressure/left ventricle stroke volume was a clear predictor of the primary end point (odds ratio [OR], 2.31; P =0.005), performing as well or better than the Pulmonary Embolism Severity Index (OR, 1.43; P =0.06) or the Bova score (OR, 1.28; P =0.01). Conclusions This study is the first study to demonstrate the utility of early pulmonary artery systolic pressure/left ventricle stroke volume in predicting adverse clinical events in patients with acute pulmonary embolism. Pulmonary artery systolic pressure/left ventricle stroke volume may be a surrogate marker of ventricular asynchrony in high-risk pulmonary embolism and should be prognostically evaluated.

Radiation therapy (RT) for patients with cancer in Jordan began with a small individual effort and has now grown to be one of the most prominent treatment centers in the Middle East. Currently, there are 4 different centers that provide RT not only for the people of Jordan but also for citizens of other neighboring Arab countries. Because Jordan is a developing country, it still faces problems with the insufficient number of RT machines available and their supporting staff (physicists and technologists among others). In this article, we shed light on the history and current status of radiation oncology in Jordan and discuss the challenges we face.

Varicoceles are often treated with percutaneous embolization, using fibered coils and sclerosing agents, with the latter targeted at occlusion of pre-existing collateral veins. While various methods of surgical and embolization treatment are available, varicoceles may still recur from venous collateralization. We present a case, where following demonstration of complete occlusion of the right and left gonadal veins, direct puncture of the pampiniform venous plexus under ultrasound guidance revealed recurrent varicoceles supplied by anastomoses from the ipsilateral saphenous and femoral veins to the pampiniform plexus. In doing so, we describe a technique of percutaneous pampiniform venography in a case where the pertinent anatomy was not easily demonstrated by other methods.

Rationale and Objectives: The technique of subtraction computed tomographic angiography (sCTA) has been proposed for the evaluation of atherosclerotic disease to address limitations in CTA in highly calcified arteries. However, sCTA has not gained acceptance in clinical practice, in part, due to image artifacts caused by patient motion that occur between the acquisition of the two component images. The purpose of this study was to evaluate the effectiveness of computational image co-registration to obtain sCTA., Materials and Methods: The study was conducted using a semi-automated implementation of the mutual information (MI) registration algorithm. The results of sCTA were evaluated quantitatively in a phantom representing a calcified artery. Technical success of sCTA was evaluated in 14 calcified arterial segments in two patients. An observer study was carried out to determine interobserver agreement in the interpretation of sCTA. Qualitative observations were made between sCTA and CTA., Results: Computation time for performing the co-registration for each 2-cm calcification is less than 1 second. The necessary user interaction required minimal expertise. Measurements of the degree of stenosis in the calcified artery phantom agreed to within 8 +/- 4% of gold-standard measurements. Technical success was demonstrated in all calcifications. Strong interobserver agreement was obtained for the detection of hemodynamically significant stenoses (kappa = 0.86). Several apparent pitfalls in the interpretation of CTA in calcified arteries were noted that could potentially be obviated by sCTA., Conclusions: The study supports the use of a straight-forward implementation of the MI algorithm and provides preliminary evidence validating the use of sCTA in the setting of atherosclerotic disease of the lower extremities.

Leukocyte adhesion deficiency type I (LAD-I) is a rare autosomal recessive immunodeficiency syndrome leading to recurrent bacterial and fungal infections. Bone marrow transplantation offers the only cure. In this report, we describe the course and outcome of bone marrow transplant in a 4 month-old female infant with LAD-I at King Hussein Medical Center, Jordan. A successful matched HLA- related allogeneic bone marrow transplantation was performed. Engraftment was demonstrated on the 12th day. The patient developed Grade III grafts versus host disease (GVHD), veno-occlusive disease of the liver, and late onset hemorrhagic cystitis. She recovered with appropriate immune reconstitution.