Individual and interactive role of Trichoderma viride and arbuscular mycorrhizal fungi on growth and pigment content of onion plants.

The study of interactions between beneficial micro-organisms associated with plant roots is important, because such interactions might either enhance or inhibit the beneficial effects of individual species. The effect of the combined inoculation of arbuscular mycorrhizal (AM) fungi and a biocontrol fungus (Trichoderma viride) on different growth parameters and chlorophyll a,b, carotenoids, total chlorophyll and total pigments of onion (Allium cepa) plants was studied under glasshouse conditions. The results proved that AM fungi and T. viride are compatible with each other and their combined use was effective not only in improving onion growth parameters such as fresh and dry weights, root and shoot lengths and leaf area but also increasing total chlorophyll, carotenoids and total pigments content in onion leaves. Where, inoculation of onion plants by AM fungi and T. viride alone or in combination significantly increased bulb diameters of onion plants 20, 12·5 and 17·5% increase; respectively, when compared with control ones. Also percentage of AM fungal colonization increased greatly with T. viride inoculation. Therefore, AM fungi and T. viride could be a good alternate of chemical fertilizer for improving the growth of onion. SIGNIFICANCE AND IMPACT OF THE STUDY: Significance and Impact of the Study: The need for increasing agricultural productivity and quality has led to an excessive use of chemical fertilizers; creating serious threats to human health and the environment. The use of biofertilizers is an alternative for sustaining high production with low ecological impact. Thus the goal of this study was to propose a biological technique using arbuscular mycorrhizal symbiosis and Trichoderma viride (plant-microbe interaction) for increasing plant growth that represent a great opportunities for recent agricultural practices. This may be an indication displaying the AM and Trichoderma significance for plant progress and growth.

Malignant peritoneal mesothelioma.

Malignant peritoneal mesotheliomas are rare tumors arising from the peritoneal surface. We report a 53 year old, non-asbestos exposed Saudi male who presented with exudative ascites. The diagnosis was obtained from laparoscopic biopsy. To the best of our knowledge this entity has not been described in the Saudi community. The aim is to increase the awareness among the medical community about this rare entity.

Hepatic granulomas in an arab population: a retrospective study from a teaching hospital in Riyadh.

This is a retrospective analysis of the medical records of 116 patients who presented to the gastroenterology division, department of medicine at King Khalid University Hospital (KKUH) in Riyadh, Kingdom of Saudi Arabia and subsequently had a histopathologic diagnosis of hepatic granulomas. Infections contributed to 56% and were represented mainly by schistosomiasis and to a lesser extent by tuberculosis, brucellosis and hydatid disease. Lymphomas (8%) were the major representative of noninfectious causes. The etiology of 25% of granulomas remained undetermined. Weight loss, fever, anorexia and abdominal pain were the most frequent presenting symptoms in 53, 45, 43 and 42% of patients, respectively. Ten percent of the patients were asymptomatic. Hepatomegaly and splenomegaly were the predominant physical findings in 55% and 43% of patients respectively. Hepatic granulomas in this study are mainly caused by infections. Schistosomiasis, tuberculosis and brucellosis represented the most common etiologic factors.

Pneumatic dilation of cardiac achalasia using low compliance balloon: University-Hospital experience.

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Mirizzi syndrome and management.

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Decortication for empyema thoracis.

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Frequency of endoscopic esophagitis in nutcracker patients with pathological 24-hour pH monitoring.

UNLABELLED: Endoscopically, it was claimed that reflux esophagitis is less frequently seen in patients with tertiary contractions. The aim of this prospective study is to evaluate the frequency of endoscopic esophagitis in nutcracker patients with pathological 24-hour pH monitoring as compared to a matched group of patients with pathological prolonged ambulatory pH monitoring. The study included eight patients with nutcracker esophagus and pathological 24-hour pH monitoring (Group 1); mean (SD) age was 36.5 (10.6) years, mean (SD) LES pressure was 11 (2.9) mmhg and % total pH < 4 was 11.5 (7), which were not statistically different from a matched control of 25 patients (Group 2). Patients with underlying definable systemic diseases were excluded from the study.. Three nutcracker esophagus and eight control showed evidence of endoscopic esophagitis (P value=0.9). Among group I, nutcracker patients with endoscopic esophagitis had a tendency towards a lower LES pressure (P=0.056) and a significantly greater % total pH < 4 (P=0.04). % upright reflux (P=0.03) and total time pH < 4 (P=0.003) than nutcracker without endoscopic oesophagitis. Moreover, nutcracker patients with endoscopic esophagitis had a significantly greater % total pH < 4 and total time pH < 4 than control group with endoscopic esophagitis with P value = 0.03 and 0.02, respectively. CONCLUSION: The frequency of endoscopic esophagitis is similar in nutcracker and a matched control with pathological 24-hour pH monitoring.

Radionuclide esophageal transit time for the assessment of pneumatic dilation in patients with achalasia.

OBJECTIVE: The aim of this study was to assess the value of radionuclide esophageal transit time (RET) in prediction of the results of pneumatic dilation in patients with achalasia. PATIENTS AND METHODS: Thirty patients (13 males) with a mean age of 37 +/- 15.6 years (range 17-73 years) were included in the study. All patients were diagnosed to have idiopathic achalasia of the cardia and selected for pneumatic dilation. Each patient had three RET, two the same day of dilation (pre-and postdilation) and a third follow up one within three months of dilation (4 patients failed to come for follow up and were excluded). RESULTS: Several parameters were derived from RET studies, T/50: time required for 50% of activity in the esophagus to be cleared, T/10 : time required for 90% of activity in the esophagus to be cleared and percentage clearance at 10 min. These parameters were compared to response of dysphagia to dilation. It was evident that the higher the esophageal clearance postdilation, the better the outcome. When immediate post dilation clearance was 85% or more the success rate was 83.3% whereas when it was 20-50% the success rate was only 21.4%. No relation was found between T/50, T/10 and dysphagia response. CONCLUSION: RET appears to be a useful quantitative procedure in the assessment of pneumatic dilation outcome in achalasia patients.

Treatment of chronic hepatitis C genotype 4 with alpha-interferon in Saudi Arabia: a multicenter study.

BACKGROUND/AIM: Several studies have indicated that there are certain predictive factors (gender, duration of infection with HCV, cirrhosis and genotype of HCV) of a better response with alpha-interferon treatment in patients with chronic hepatitis C. The aim of this study was to evaluate these factors in Saudis and other Arab nationals with chronic hepatitis C-genotype 4-undergoing alpha-interferon treatment. METHODOLOGY: A multicenter study was conducted between 1992 and 1994 on 80 consecutive patients who were prospectively recruited and randomized in treatment and control groups. RESULTS: The results of this multicenter study indicated a low response rate to alpha-interferon with an overall response rate of 43%, of which 28% was complete. The sustained response was only 16%. Among the reasons for this low response in our study are the high percentage of patients with cirrhosis and the long infection interval, as about 80% of our HCV cases were community-acquired. CONCLUSION: Liver cirrhosis was found to be the main predetermining factor for response to interferon treatment. Genotype 4 was not a contributing factor to the difference in response rate.

The prevalence of endoscopic esophagitis in duodenal ulcer patients and symptomatic controls.

BACKGROUND: A large series of duodenal ulcer patients was examined in order to determine the prevalence rate of reflux esophagitis and compare it to that of a series of symptomatic controls, as well as to find out if complicated duodenal ulcer patients are at a higher risk of developing reflux esophagitis. PATIENTS AND METHODS: All consecutive patients attending the Endoscopy unit between January and December 1996 who were found to have duodenal ulcers were prospectively recruited for this study. Consecutive patients with upper abdominal symptoms but negative gastroscopy for duodenal ulcers were used as a control. Patients known to have reflux esophagitis, those on peptic ulcer treatment for more than a week, those with dysphagia as a presenting symptom or underlying upper gastrointestinal malignancy, and patients who had undergone previous ulcer surgery were excluded from the study. A hundred and forty-one patients were found to have duodenal ulcer (Group I), and one hundred and seventy-two served as a control (Group II). The two groups were matched for age, NSAID ingestion and smoking habit. However, Group I included significantly more patients with underlying co-morbid conditions and fewer females. RESULTS: The prevalence of reflux esophagitis was similar between both groups, 30.5% vs. 38.4%, P=0.18. Furthermore, bleeding duodenal ulcer patients (sub-group III) were compared to non-bleeding duodenal ulcer patients (sub-group IV). Although Group III included significantly more smokers, NSAID ingestion and comorbid conditions, there was no significant difference in the prevalence rate of reflux esophagitis, P=0.13. Moreover, 92.7% of afflicted patients suffer mild or moderate esophagitis. CONCLUSION: Endoscopic esophagitis is a frequent finding in both duodenal ulcer and control subjects.

Extracorporeal shock wave lithotripsy for the rescue of post-endoscopic or surgically retained biliary duct stones: does saline irrigation affect the outcome?

Extracorporeal shock wave lithotripsy (ESWL) has been found valuable in situations where obstructing stones in the common bile or intrahepatic ducts are retained following surgery or attempted endoscopic removal. However, success rates are dependent on the type of ESWL system employed and upon a high frequency rate of repeated treatment sessions. We outline our experience with 23 cases of retained, obstructing bile duct stones, ranging in size from 10 to 40 mm diameter, treated with Dornier HM3 ESWL. In the initial 12 patients in the series, successful stone fragmentation occurred in 83% of cases with a median 1.6 treatment sessions. In the latter 11 cases in the series, patients were treated prone and the stone-bearing biliary duct was irrigated with saline solution during ESWL delivery. With this technique, successful stone break up was achieved in all patients (100%) with a single treatment session. Endoscopic sphincterotomy is, however, a prerequisite for extracorporeal lithotripsy and, despite the high success rates now available with new techniques, we believe the ESWL should continue to be employed in support of primary endoscopic methods of management for obstructing bile duct stones.

Pattern of Helicobacter pylori sensitivity to various antimicrobial agents.

To evaluate the pattern of Helicobacter pylori ( H. pylori ) susceptibility to different antimicrobial agents, we prospectively studied 45 H. pylori isolates by disc diffusion method. These isolates were obtained from patients aged between 16-75 years, of both sexes who had no prior history of metronidazole ingestion. A total of 45 patients were included, of which 36 were males with a mean age of 42.9 years and nine females with a mean age of 36.4 years, 62% of patients were Saudis. Almost all the H. pylori isolates were susceptible to clarithromycin, penicillin, erythromycin, ampicillin, tetracycline, clindamycin and cephradine. However, 64.4% of the isolates were resistant to metronidazole. No significant difference was found either in susceptibility of isolates from Saudi, non-Saudi or male and female patients.

Biliary leak: Endoscopic management.

The objective of this study was to evaluate the effectiveness of endoscopic treatment in patients with biliary leak. The study was performed at King Khalid University Hospital in Riyadh. We used retrospective analysis of the complete records of 18 patients with biliary leak treated endoscopically over a period of 10 years. The mean age was 41.11 +/- 14.54 years. Ten were male. The leak was complicating cholecystectomy, biliary surgery for hydatid cysts and road traffic accidents in 15, two and one patients. Of the 17 patients cystic duct remnant in 11, common bile duct in three and intrahepatic duct in four patients. Of the 17 patients who had endoscopic papillotomy (EPT), this procedure was combined with stenting in 11, with stone retrieval in two, with stone retrieval and stenting in three and with dilatation of a stricture in one patient. Another patient was treated with a stent without papillotomy. In all patients, the leak healed and the stent was removed after a mean stenting duration of 65.12 +/- 41.89 days. No complications were encountered in this group of patients. Endoscopic management of biliary leak is a simple, safe and effective therapeutic method. Therefore, we recommend its application as first-line management of biliary leaks.

Tuberculous peritonitis in chronic liver disease: Clinical features and response to treatment.

To find out the clinical presentation, laboratory results, and treatment response of tuberculous peritonitis in patients with chronic liver disease, we retrospectively reviewed the medical records of all patients with tuberculous peritonitis diagnosed by laparoscopy at King Khalid University Hospital over a period of seven years. A total of 17 patients (Group 1, consisting of 11 males and six females with a mean age of 539 +/- 17.5 years) had both chronic liver disease and tuberculous peritonitis, while 27 patients (Group 2, consisting of 17 males and 10 females with a mean age of 39.5 +/- 16.3 years) had only tuberculous peritonitis. Tuberculous peritonitis in chronic liver disease had similar clinical and laboratory presentation compared to patients with tuberculous peritonitis but without liver disease. However, Group I were significantly older, had lower ascitic protein content and higher mortality (P values of 0.004, 0.002, and 0.02, respectively). Both groups responded favorably to specific therapy. The overall mortality was recorded as 5.6%. In conclusion, the clinical presentation of tuberculous peritonitis in patients with chronic liver disease is similar to that of patients without liver disease except for ascitic protein, which is lower in the former group of patients. The prognosis is good with specific therapy.

Colonic polyps: Experience from King Khalid University Hospital.

To find out the frequency rate and anatomical distribution of colonic polyps in patients attending King Khalid University Hospital, we retrospectively reviewed all colonscopic files between 1406-1415 AH. Of 2772 patients who underwent colonoscopic examination, 109 patients (75 males and 34 females, mean age of 43.5 +/- 19 years) were found to have a total of 188 polyps. There were 73 Saudis; 47 males with a mean age of 48.6 +/- 17.4 years and 26 females with a mean age of 42.4 +/- 17.9 years. Polyp frequency rates in the whole group and in Saudi patients were 3.93% and 4.0%, respectively. There were 124 (66%0 polyps which were sessile. The majority of polyps (82%) were located in the left side of the colon. Tubular and tubulovillous adenoma constituted 89.5% of all histological reports of neoplastic polyps. Synchronous colonic pathology was observed in 32 (29.4%) patients. This shows that the colonic polyp frequency rate is low. The left side of the colon accommodated most of these polyps.

Frequency of peptic ulcers in patients with portal hypertension.

To find the frequency of peptic ulceration in portal hypertension, 137 patients with portal hypertension were studied retrospectively. Patients with hepatocellular carcinoma, other malignancies or underlying severe systemic disease were excluded and the remaining 114 patients were included in the study. There were 81 males (mean age 49.1 +/- 13.7 years) and 33 females (mean age 52.9 +/- 10 years). Portal hypertension was secondary to viral liver disease in 75%. Fifty-seven patients had no evidence of peptic ulcers (group I) and another 57 patients (group II) had peptic ulcers diagnosed during upper gastrointestinal endoscopy. There was no significant difference between the two groups regarding age, sex, Child-Pugh score or variceal size. Duodenal ulcers were found in 24% while gastric ulcers were found in 4.4%; other endoscopic findings included erosive gastritis and duodenitis in 21% and 18.4% respectively. Twelve percent of the patients from group II developed bleeding from the ulcers and the majority of bleeding ulcers responded to conservative treatment. The study concludes that the frequency of peptic ulcers in patients with portal hypertension is high. Bleeding peptic ulcers respond to conservative treatment.

Treatment options for large common bile duct stones.

This is a retrospective analysis of the medical records of patients diagnosed to have large common bile duct stones (> 15 mm). The study was designed to evaluate different modalities of large bile duct stone treatment. The setting is King Khalid University Hospital, Gastroenterology Unit. The medical records of patients (n=64) diagnosed to have large common bile duct stones by endoscopic retrograde cholangiography over a period of nine years were included. Files were reviewed and information obtained which included patients' age, sex, nationality, presenting symptoms, number and size of bile duct stones, presence of ascending cholangitis, mode of treatment received, complications and outcome. There were a total of 64 patients; 28 males and 36 females, with a mean age of 61 + 16.6 years. Successful stone extraction was achieved in 44 (69%) patients while surgical treatment was required in 20 patients. Surgically managed patients had significantly larger stones (P<0.003) and were more frequently jaundiced (P<0.014). There was 7.8% of the total number of patients who developed complications that were managed conservatively with full recovery. It was concluded that large stones are difficult to extract endoscopically and more frequently require additional treatment.

Spontaneous bacterial peritonitis.

Spontaneous bacterial peritonitis (SBP) is an infection of the ascitic fluid without obvious intra-abdominal source of sepsis; usually complicates advanced liver disease. The pathogenesis of the disease is multifactorial: low ascitic protein-content, which reflects deficient ascitic fluid complement and hence, reduced opsonic activity is thought to be the most important pathogenic factor. Frequent and prolonged bacteremia has been considered as another pertinent cause of SBP. This disease is associated with high mortality and recurrence. Therefore, orompt recognition and institution of therapy and plan of prophylaxis is vital.

Variceal bleeding: management options.

Portal hypertension with esophageal varices represents an important source of upper gastrointestinal bleeding. Variceal bleeding is associated with high rebleeding and mortality rates. Various treatment modalities are effective in control of bleeding. Endoscopic Sclerotherapy (ES) is the standard method for management of acute variceal bleeding alone or in combination with vasoactive drugs. Alternative methods are considered in case of sclerotherapy failure. Portosystemic shunt operation is complicated by systemic encephalopathy. Therefore, it is replaced by other surgical procedures. These include esophageal stapled transection, splenectomy with devascularization, distal splenorenal shunt (DSRS), DSRS combined with pancreatic disconnection, narrow diameter mesocaval (NDMC) or portocaval (NDPC) shunts and liver transplantation. Recently. transjugular intrahepatic portosystemic stent-shunting (TIPSS) has been introduced in the management of patients with refractory variceal bleeding waiting for liver transplantation.