Malignant biliary strictures. Diagnosis and management

To identify the cause, methods of diagnosis and management of malignant biliary strictures in our institution and compare with studies from other communities. From March 1998 through to August 2002, we reviewed 1000 files of patients who underwent endoscopic retrograde cholangiopancreatography [ERCP] at the Gastroenterology unit, King Khalid University Hospital in Riyadh, Kingdom of Saudi Arabia for malignant biliary strictures [MBS]. Clinical, laboratory data, method of diagnosis and management were recorded. Seventy-two patients [72/1000] with MBS were encountered. Forty one [57%] were males and 31 [43%] were females and the majority were Saudi nationals [82%]. Jaundice and right upper quadrant pain were the most frequent symptoms in 84.7% and 52.8% of patients. Cholangiocarcinoma was present in 31 [43%] and pancreatic adenocarcinoma in 23 [31.9%] patients. Other malignancies found included gallbladder carcinoma in 5 patients [6.9%], ampullary carcinoma in 5 [6.9%], metastatic liver carcinoma in 4 patients [5.6%], hepatocellular carcinoma in 2 [2.8%] and lymphoma in 2 [2.8%]. The diagnosis was entertained mainly by ERCP [93%]. Endoscopic palliation was carried out in 77.8% of patients, percutaneous transhepatic drainage in 13.9% and surgery in 6 [8.3%]. The mean survival was higher for the endoscopic compared to the percutaneous transhepatic and surgery groups [6.9 +/- 4.13, 4.27 +/- 4.29 and 3.67 +/- 2.65 months]. In non-resectable tumors, ERCP is the optimal method of diagnosis and palliation of MBS

Hepatitis A in Saudi Arabia: a comparative sero-epidemiological study

To determine the prevalence of Hepatitis A Virus infection among Saudi children [1-12 years] in 1997. To compare the results with our previous study in 1989. This is a randomized community-based study involving all of the regions of Saudi Arabia. All children were tested for antibody Hepatitis A Virus immunoglobulin [IgG] class. The prevalence of anti-Hepatitis A Virus IgG among 5355 Saudi children tested ranged from 10% in Taif to 82% in Gizan regions with an overall prevalence of 25%. There is a reduction of the overall prevalence from 50.5% in 1989 to 25% in 1997. This study shows a marked decline in Hepatitis A Virus infection in Saudi children 8 years after the first study. There is an almost 50% reduction of the overall Hepatitis A Virus prevalence. This dramatic decline in Hepatitis A Virus infection among the Saudi children will lead to a later exposure of elderly population groups to the Hepatitis A Virus infection and a new preventive strategy needing to be adopted

Brucellosis in Saudi Arabia: diverse manifestations of an important cause of pyrexial illness

A retrospective analysis of the medical records of 70 patients with brucellosis seen at King Fahd Hospital of King Faisal University was carried out. Male to female ratio was 2.3:1, with a median age of 35 years [range=5-70 years]. Eighty-seven percent were Saudi. Fever, back and joint pain, and excessive sweating were the commonest presenting symptoms, occurring in 95%, 36% and 34%, respectively. Splenomegaly, hepatomegaly, and lymphadenopathy were detected in 27%, 23% and 10%, respectively, and 16% had signs of arthropathy. Sixty-four percent of the patients were found to be anemic. Leucopenia, neutropenia and leukocytosis were found in 31%, 30% and 10% of patients. Blood cultures for Brucella were positive in 28 out of 55 tested patients [51%]. In a retrospective analysis of 231 patients with pyrexia without an apparent etiology, brucellosis was found to be the commonest cause, accounting for 23% of all reviewed cases. In the text we compared some data with data reported recently from Riyadh. We conclude that human brucellosis has diverse clinical manifestations and high index of suspicion is needed for its early recognition. We also conclude that it represents a frequent cause of pyrexial illness