Hepatic manifestations of Wilson's disease: frequency and pattern in Saudi patients.

Seven symptomatic patients with Wilson's disease have so far been diagnosed at King Khalid University Hospital (KKUH), Riyadh, over the last six years. On family screening, another three asymptomatic patients were found to be affected. Five of the symptomatic patients had clinical features of liver disease on initial presentation and was preceded by renal dysfunction in another patient. The remaining patient presented with neurological features. Six patients had Kayser-Fleisher ring. Abnormal liver function tests were found in half of the patients. Ceruloplasmin was reduced in 7 of 10 patients. Serum copper and urinary copper estimations were most useful diagnostic laboratory tests. Morphological alteration was found in all 9 patients who had a percutaneous liver biopsy. All patients were treated initially with D-penicillamine and clinical response was noted in seven, of whom one developed neurological manifestations while receiving the treatment. D-penicillamine was replaced by zinc sulfate in 3 patients who developed thrombocytopenia. The data suggest that Wilson's disease may not be rare in Saudi Arabia. For early detection and prompt treatment, the disease should be suspected under appropriate clinical circumstances especially in young patients with liver diseases. Close relatives of such index patients should be routinely screened.

Helicobacter pylori; histological and cultural correlation in chronic gastritis.

Seventy seven antral biopsies were collected from patients attending endoscopy clinic at King Khalid University Hospital, Riyadh, Saudi Arabia during a period of six months between December 1988 to May 1989. Of these 69 (89.6%) showed chronic gastritis as well as Helicobacter-like organisms (HLOs) in the biopsy specimens while 63 (81.8%) of biopsies grew Helicobacter pylori on culture. These findings indicate a good correlation between the histological diagnosis of chronic gastritis and isolation of H. pylori on culture.

Use of selective and non-selective media for the isolation of Helicobacter pylori.

Antral biopsy specimens from patients having gastroduodenal disorders were cultured in parallel on sheep blood agar (SBA) and Skirrow's selective medium (SSM) for Helicobacter pylori. It was found that the overall isolation rate of the organism was much lower in SSM (54.5%) than on SBA (87.9%), a difference which is statistically significant (P less than 0.01). This may be due to the incorporation of polymyxin B in SSM. In absence of a suitable selective medium, blood agar may be used. Although consideration must be given to contamination, we found that contamination of SBA culture plates was not significant enough to hamper the isolation of the organism in the vast majority of the cases (98.5%).