Formol-ether concentration method in the diagnosis of active schistosoma mansoni in patients with detectable IHA.

Schistosomiasis is a world wide human infection. In Saudi Arabia there are multiple endemic foci. Various methods have been used to diagnose Schistosoma mansoni. We studied 1410 patients coming from S. mansoni endemic areas with detectable antibodies by indirect hemagglutination (IHA). Stool specimens were tested for S. mansoni ova by direct smear and formol-ether concentration (FEC) methods. The objective of the study was to identify patients with active schistosomiasis using FEC method and a single direct smear. Twenty percent of IHA positive patients had active infection detected by FEC, while a single direct stool smear diagnosed only 2.4% (P< 0.0001). The percentage of positive FEC was significantly increasing in linear trend with IHA level. This trend wasn't observed with direct smear examination. The current data suggest that FEC is helpful to diagnose active schistosomiasis, therefore it is recommended in IRA positive individuals.

Esophageal candidiasis among a dyspeptic population.

This is a retrospective study of 59 patients endoscoped over a period of six years at a private clinic and were found to have esophageal candidiasis. The median age was 46.38 years. Thirty (51 %) patients had no precipitating factors. Only 18 (30%) patients had typical symptoms. The distal part of the esophagus was more often involved. The thrush was scattered in 57 (97%) patients. The endoscopic finding was confirmed by cytology in all patients included. Symptoms improved on oral nystatin treatment and simultaneous treatment of associated conditions in all 46 patients followed up. In conclusion, esophageal candidiasis appear to be not uncommon among dyspeptic population. It presents more frequently with atypical symptoms and responds well to oral nystatin treatment.

Doxycline-induced esophageal ulcerations.

Over a period of six years 16 patients presented to Dr. Al Mofarreh's polyclinic with drug--induced esophageal ulcerations. One patient had esophagitis without ulcerations and two patients, who declined endoscopy were not included in this analyzis. The mean age of the remaining 13 patients was 28.92 +/- 10.39 years. The mean ulcers number was 3.69 +/- 2.76. The ulcers were located at the mid-esophagus, 29.23 +/- 3.94 cm from the incisors teeth. Odynophagea, retrosternal pain and dysphagea in 13 (100%), 12 (92%) and 9 (69%) patients, respectively, were the most frequent presenting symptoms. All patients took a doxycycline preparation at bed time with little water. The mean elapse between the drug intake and endoscopy was 7.85 +/- 9.96 days. The symptoms resolved within a maximum of one week of antireflux treatment despite the continuation of doxycycline therapy in three patients with brucellosis. The current data confirmed the role of oral doxycycline intake, the timing and the amount of concurrent fluid in the etiology of esophageal ulcerations.

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.

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.

Pattern of primary gastrointestinal tract malignancy among Saudi nationals: A retrospective study.

This histopathological reports from the central laboratory of Riyadh Central Hospital for between 1404 to 1406H (1984 to 1986) were reviewed retrospectively to determine the pattern of primary cancer of the gastrointestinal tract among Saudi nationals. During the study period, a total of 32,990 histopathological examinations were conducted. Neoplasms were identified in 4683 cases (14.2%); 1772 (37.8%) were malignant and 2911 (62.2%) were benign. The stomach (31%), liver (20%), and esophagus (19%) were the most commonly involved organs. The proportional frequencies of gastrointestinal malignancies differ from those seen in Western countries, although the age and sex distribution are similar. The possible etiological factors are discussed and the need for a cancer registry emphasized.

Transabdominal gastro-oesophageal devascularization and oesophageal transection for bleeding oesophageal varices.

Fifty consecutive unselected patients presenting with acute haematemesis and melaena from endoscopically confirmed bleeding oesophageal varices were treated by one-stage transabdominal oesophageal transection with gastro-oesophageal devascularization and splenectomy. According to Child's classification, 15 were Grade A, 29 Grade B and six Grade C. The mortality rate was 10 per cent. Postoperative complications included gastric fundal leak (4 per cent), pleural effusion (4 per cent), subphrenic abscess (2 per cent), atelectasis (2 per cent) and pneumothorax (2 per cent). Although five patients (10 per cent) complained of transient dysphagia during follow-up, only one (2 per cent) presented evidence of stricture at the site of oesophageal transection. Clinical encephalopathy was not present in the surviving patients in the postoperative period. No recurrence of bleeding has been recorded in the surviving patients over a follow-up period of 2-3 years.