Association of gastric lymphoid follicles and Helicobacter pylori infection.

Lymphoid tissue is normally absent in the gastric mucosa; however, lymphoid follicles are very frequently noted in Helicobacter-associated gastritis. We reviewed 237 cases of chronic gastritis with lymphoid follicles. Out of this 227 cases (95.8%) were found to have H. pylori infection. The significance of this finding and its possible relationship to primary gastric lymphoma are discussed.

Congenital hepatic fibrosis: A study of a Saudi family and review.

A Saudi family with three members afflicted with congenital hepatic fibrosis (CHF) is described. CHF was associated with cystic dilatation of the intrahepatic bile ducts and autosomal dominant polycystic kidney disease (ADPKD) in all of the three siblings. The proband's case report is presented and the detection of the other two children by family screening is described. This is the first report of CHF in a Saudi family. Review of the disease is outlined.

Primary sclerosing cholangitis in chronic ulcerative colitis: report of cases in Arabs and review.

Primary sclerosing cholangitis (PSC), a chronic cholestatic liver disease, is increasingly recognized in association with chronic ulcerative colitis (CUC). Two cases of PSC were diagnosed among 78 Arab patients (2.7%) with CUC followed up at Riyadh Central Hospital. Detailed case reports of the patients and review of PSC are presented, in order to draw attention to a hitherto under-diagnosed condition. This is the first report of PSC among Arabs.

The role of ERCP in the management of gallstone-associated acute pancreatitis: A prospective study of 64 patients at Riyadh Central Hospital.

In a prospective study, consecutive patients admitted to one of the surgical units at Riyadh Central Hospital with a diagnosis of acute biliary pancreatitis (ABP) underwent, after stabilization, urgent ERCP within 72 hours of admission. A total of 64 patients (35 males, 29 females) were treated over a four-year period (1986-1990). Forty-eight patients were found to have common bile duct stones when endoscopic sphincterotomy (ES) and stone extraction was performed, including four patients with concomitant cholangitis. This was followed by a significant decrease in mean values of the biochemical parameters; serum amylase, SGOT, total bilirubin (P < 0.001) and alkaline phosphatase (P < 0.02), with a corresponding clinical improvement. Urgent ERCP+ES was not associated with any serious complications. There was no hospital mortality in this series. Details of the endoscopic findings and treatment are summarized. Based on the present study and others cited, the role of ERCP in the diagnosis and management of ABP are discussed and recommendations suggested.

Diabetes mellitus in Saudi Arabia: The clinical pattern and complications in 1,000 patients.

A retrospective and prospective study of 1,000 ambulatory and hospitalized diabetic patients was done in Riyadh, Saudi Arabia. Saudis completed 777 (77.7%) and non-Saudis 223 (22.3%). Sex distribution was equal among Saudis, males 389 (50.1%) and females 388 (49.9%), but non-Saudi males were predominant at 153 (68.6%), non-Saudi females 70 (31.4%) reflecting the preponderant male expatriate labor force. A proportion of different types of diabetes was: IDDM 115 (11.7%), non-obese non-insulin dependent diabetes mellitus (NIDDM) 405 (41.0%), obese NIDDM 412 (42.1%), and early onset non-insulin dependent diabetes (diagnosis under 30 years of age), 43 (4.4%). Regarding treatment, 388 (40.6%) received insulin followed by sulfonylurea, alone in 330 (33.5%), diet only 117 (12.0%), combination sulfonylurea and biguanide in 113 (11.6%), biguanide alone in 13 (1.3%) and insulin plus tablets in 7 (0.8%). Of 472 and 426 patients, 29.7% and 30.0% had elevated total cholesterol or triglycerides respectively, while 77.2% of 373 patients had elevated glycosylated hemoglobin (HbA1). At least once in 998 patients, diabetic ketoacidosis occurred in 7.6%.

Periampullary cysts: endoscopic management.

Periampullary cysts are a rare but remediable cause of recurrent pancreatitis. Hitherto, the management of such cysts was mainly surgical. We report on two cases of periampullary cysts. The first patient, who had a cyst of the minor papilla (Santorini cyst), presented with upper gastrointestinal hemorrhage and a history of recurrent pancreatitis. The second patient presented with cholangitis. Both were successfully and safely treated by endoscopic methods alone. Details of the cases and the endoscopic techniques used are fully described.

Crohn's disease in Arabs.

Crohn's disease is widely described in the Western literature, but it has not been widely observed in the Middle Eastern community. We diagnosed Crohn's disease in seven Arabs, three whom were Saudi Nationals. Their mean age was 32.4 years (range, 18-40 years) and duration of symptoms varied from three months to ten years. The site of the disease was ileocolic in five patients and colonic in two. Mass lesions in the abdomen were seen in three patients. Four cases were diagnosed from histological specimens obtained at laparotomy and resection and the other three were diagnosed from colonoscopic biopsy specimens. Extraintestinal manifestations were found in three patients. Surgery alone was the treatment in two patients, whereas the remaining required medical therapy, mainly steroids, with or without surgery. We conclude that Crohn's disease does occur in the Arab population, but with milder systemic effects.

Hydatidosis: clinical significance and morbidity patterns in Saudi Arabia.

Hydatid disease is an endemic zoonosis in Saudi Arabia causing a significant morbidity among Saudi nationals. The complications can be severe and life threatening. Seventy seven cases are presented with their salient clinical manifestations, organs affected, complications and methods of diagnosis. It was noticed that females are more commonly affected than males, and the younger age groups are commonly affected.

Ramadan fasting and non-insulin-dependent diabetes: effect on metabolic control.

The effect of fasting during the holy month of Ramadan on the metabolic control of 39 patients with overweight and non-insulin-dependent diabetes (NIDD) was studied. There were 29 females and 10 males with a mean age of 51.5 +/- 1.65 years and body mass index of 31.5 +/- 0.98 kg/m2. All were treated with diet and oral hypoglycaemic agents (OHA). There was no change in body weight, fasting plasma glucose, glycosylated haemoglobin (HbA1), C-peptide and insulin blood levels at the end of fasting. Total blood cholesterol concentration rose significantly (p 0.05) but not triglycerides at the end of Ramadan. There were no acute metabolic complications (e.g. hypoglycaemia) in the present study. We conclude that fasting during Ramadan is generally safe in NIDD. However, patients should be advised to make use of this opportunity to combine the spiritual benefit with improvement in the metabolic control of the diabetes mainly through weight reduction.

Obesity and major metabolic indices in newly diagnosed Saudi diabetic patients.

Metabolic indices were assessed in 217 Saudi diabetic patients and 57 control subjects in relation to Body Mass Index (BMI). Patients with BMI values greater than or equal to 27 in male and greater than or equal to 25 in female were considered obese. Obesity was found more frequent in females (82.7%) than in males (40.9%) (p less than 0.01). Basal glucose and HbA1C levels were lower in obese males than in females. C-peptide levels were higher (p less than 0.01) in the obese subjects than in the non-obese. Within the obese group c-peptide levels were higher in males than in females. Triglycerides and total lipids were also higher in the obese group. Our result suggests that a varying degree of obesity influences the rate of both beta cell secretion, insulin resistance and impaired lipid metabolism.

Hepatitis B virus vs schistosomiasis and hepatocellular carcinoma in Saudi Arabia.

Fifty patients with histopathological diagnosis of hepatocellular carcinoma were studied with special reference to infection with hepatitis B virus and schistosomal infestation. The possible correlation of these two risk factors and liver malignancy is discussed.

Endogenous insulin secretion in newly diagnosed diabetic patients in Saudi Arabia.

Diabetes mellitus is a major health problem in Saudi Arabia. The evaluation of endogenous insulin secretion at diagnosis has not yet been studied in this population. We have therefore studied fasting and post-glucagon stimulation levels of glucose, insulin and C-peptide in 216 newly diagnosed untreated diabetic patients. The mean +/- SD fasting insulin and C-peptide levels were 14.0 +/- 1.8 microU/ml and 1.8 +/- 0.4 ng/ml, while post-glucagon stimulation levels were 21.1 +/- 3 microU/ml and 2.4 +/- 0.4 ng/ml. There were significant post-stimulatory increment levels for insulin, from 4.9 to 13.7 microU/ml, and C-peptide from 0.2 to 1.3 ng/ml (P less than 0.001). Such increments did not affect specified age distribution. We found a significant correlation between the fasting levels and post-stimulation levels of C-peptide and insulin. Obesity correlated with higher basal and post-stimulation levels of both hormones (r = 0.67, P less than 0.001). The mean +/- SD fasting insulin and C-peptide levels were 18.5 +/- 9.1 microU/ml and 2.4 +/- 0.8 ng/ml for obese patients and 11.5 +/- 5.1 microU/ml and 1.9 +/- 1.1 ng/ml for non-obese patients. The type of diabetes among the Saudi adult diabetic patients studied is characterized by high basal C-peptide and insulin levels which increase significantly with stimulation, suggesting diminished but present endogenous B-cell function.