Widespread tuberculous calcification.

We are reporting an unusual case of widespread abdominal calcifications, in the peri-colic mesentery, liver and spleen. The diagnostic laparoscopy showed multiple encapsulated calcified hard rounded masses of varying size and shape, with marked adhesions in and around the bowel and mesentery. Histopathology identified them as calcified lymph nodes, but was unable to highlight the pathogenesis of these calcifications. The diagnosis of post tuberculous calcification of lymph nodes is made on the basis of exclusion. The subject was reviewed, to the best of our knowledge, there is no similar case, with such an extent of abdominal calcifications reported in the literature.

Endoscopic features of Helicobacter pylori induced gastritis.

It's still controversial whether certain macroscopic endoscopic features can be used to diagnose Helicobacter pylori (HP) related gastritis. The literature dealing with this subject is confusing, because of the lack of precise terminology, no large control trials, major discrepancies in interpretations of macroscopic changes and poor correlation of the macroscopic appearance and histological finding of gastritis. We conducted a prospective study of 208 dyspeptic patients, who underwent upper gastrointestinal endoscopies from February 1997 to June 1997. Only those patients who had either normal looking gastric mucosa or macroscopic gastritis were included in the study. Endoscopically normal looking mucosa was seen in 67 patients (65.6%), erythematous gastritis in 51 (74%), mosaic appearance in 18 (88%), erosive gastritis in 14 (85%), nodular gastritis in 17 (94%), atrophic gastritis in 12 (75%), and fundal rugae hypertrophies in 5 (80%). We suggest that the antral nodularity, raised erosions, mosaic appearance and mixed findings, are the reliable indicators of the underlying HP induced gastritis. However, these endoscopic findings are very specific, though not sensitive, for HP gastritis.

Hepatic tumors in a Saudi patients population.

Cytological diagnosis of one hundred and fifteen patients who had fine needle aspiration (FNA) of liver masses during the period from January 1987 to December 1993 was reviewed. Primary hepatocellular carcinoma (HCC) was the most common diagnosis in 87 patients (76%) with a male predominance of 82%, HBsAg and HCV antibodies were positive in 46 and 62% of patients, respectively. HBcAb was positive in 87% of patients. The median alphafetoprotein (AFP) level was 902 ng/ml. Sixty-two patients had AFP more than 200 ng/ml (normal range up to 8 ng/ml). Abdominal pain and liver mass were the most common clinical presentations in 88 and 90%, respectively. Raised ALT and AST were noted in 78 and 93%, respectively. Sixty-two percent of patients had low serum albumin less than 35 g/L. In conclusion, HCC was the predominant finding in patients presenting with liver mass. HCV antibodies were frequently associated with HCC. AFP of 200 ng/ml or more was diagnostic of HCC in those patients and may negate further histological confirmation in those who are moribund or have serious coagulation disorders.

Pattern of liver disease in a Saudi patient population: a decade of experience at security forces hospital, Riyadh, KSA.

We report the pattern of liver disease revealed by a study of liver biopsies of 277 adults aged 16-85 years old from January 1983 - December 1993. The most common histological diagnoses were: cirrhosis in 22.3%, chronic active hepatitis (CAH) 16.6%, hepatocellular carcinoma (HCC) in 7.2%, fatty changes in 12% of patients. Less common diagnoses included: Cholestasis in 8 (2.8%), Hemochromatosis in 7 (2.5%), periportal fibrosis in 4 (1.4%), Wilson's disease in 3 (1%), Alcoholic hepatitis in one patient and lymphoma in one patient. Inadequate specimens were encountered in 7 (2.5%). The commonest causes of liver cirrhosis were: Hepatitis C virus (HCV) in 73.3% of patients tested for it and hepatitis B virus (HBV) in 23.2%. Complications related to the procedures were exceedingly low. One patient, with Budd-Chiari Syndrome required emergency laparotomy to control bleeding. In conclusion, liver cirrhosis, CAH and HCC were common patterns of chronic liver disease in this series. HCV was the most common cause of CAH and liver cirrhosis.