Visceral leishmaniasis in Gizan, Saudi Arabia.

Visceral leishmaniasis is endemic in southern Saudi Arabia. We prospectively evaluated 121 patients with visceral leishmaniasis at King Fahad Hospital in Gizan. All patients were infants and children. Seasonal variation was observed with more cases presenting in late spring and summer and few in winter. The predominant clinical features in these patients were chronic fever, abdominal distention, weight loss and hepatosplenomegaly. Lymphadenopathy was rare in contrast to African kala-azar. Common laboratory abnormalities included anemia, leukopenia, thrombocytopenia, hypoalbuminemia and hypergammaglobulinemia. Liver function tests were deranged in one-third of patients. Leishmania hemagglutination test was positive in all patients and all of them had positive bone marrow smear or culture for Leishmania donovani. Patients responded well to stibogluconate (Pentostam) therapy with a cure rate of 96.7%. Four patients died in the first few days of therapy. Jaundice and grossly deranged liver function tests were found to be bad prognostic signs.

Some unusual presentations of hepatic amoebiasis in Enugu, Nigeria.

Eighty-two cases of hepatic amoebiasis were diagnosed and treated at the University of Nigeria Teaching Hospital during a 4-year period. Typical or classical features were observed in 75 (91.4%) of the cases while the remaining seven presented atypically or unusually. These were obstructive jaundice (three cases), coma (two cases) and pyrexia of unknown origin (two cases). All the cases had positive gel diffusion precipitation test for amoebic antibodies, and in all but one there was demonstration of an abscess cavity. In the three cases of obstructive jaundice, the abscess cavities were located close to the hilum and compressed the main bile duct. There was no mortality recorded especially in the jaundiced cases despite the grave prognosis associated with jaundice in hepatic amoebiasis. This study demonstrates the need to consider hepatic amoebiasis in an area when patients present with either obstructive jaundice, coma or pyrexia of unknown origin and to do ultrasonography as an initial investigation in such patients.

Intestinal permeability in diabetic diarrhoea.

Small intestinal permeability to mannitol and lactulose was studied in 12 patients aged 36-70 (mean 56) years with diabetic diarrhoea (DD). Ten uncomplicated diabetics aged 24-56 (mean 37) years and 25 normal subjects aged 22-60 (mean 37) years served as controls. Permeability was assessed by measuring urinary recovery of the test substances after oral ingestion. Mean lactulose excretion in patients with DD was significantly lower than in normal controls but was not significantly different from the uncomplicated diabetics. Mean lactulose excretion was not significantly different in the three groups. However, lactulose to mannitol excretion ratios (LMER) were significantly higher in patients with DD compared to the controls or the uncomplicated diabetics. LMER in seven patients with DD were outside the normal range. LMER in patients with DD did not correlate with blood urea, small intestinal transit time, faecal fat excretion, small intestinal bacterial overgrowth, duration of diabetes or duration of diarrhoea. Jejunal morphology was normal in all patients with DD. It was concluded that small intestinal permeability was abnormal in some patients with DD and that this might be a factor in the aetiology of the diarrhoea.

Liver biopsy: experience at Enugu, eastern Nigeria.

A retrospective analysis of liver biopsies done at the University of Nigeria Teaching Hospital, Enugu, between January 1980 to December 1985 was done to determine the indications, level of preparation and investigation of the patients, biopsy techniques and failure rate, complications and histopathological results. The register of all biopsies sent to the Morbid Anatomy Department and the clinical records of the patients were used for the analysis. Of the 154 biopsies done, the Menghini technique was used in 128 cases (83.1%), the rest was by exploratory laparotomy. The commonest indication was unexplained hepatomegaly with or without splenomegaly 46 cases (29.8%). Adult cases accounted for 132 cases (85.7%) with male/female distribution of 3:1. Histologically proven cases of hepatocellular carcinoma accounted for 38 cases (14.2%). Pain requiring analgesics occurred in 8 cases (5.2%). The need for adequate clinical documentation of patients is emphasized.

Gastric acid secretion studies in Enugu, using pentagastrin stimulation.

Mean acid output was studied in forty-three Nigerian subjects (twenty controls and twenty-three duodenal ulcer patients). 6 micrograms/kg body weight of pentagastrin was given to each after 1 hour basal acid output (B.A.O.) collection. Maximal and peak acid outputs (M.A.O. and P.A.O.) were measured in mmol/hr using the indicator-titration method. Gastric juice volume was measured in mls. For the control the B.A.O., M.A.O. and P.A.O. in mmol/hr were (Mean 1 S.D.) 1.7 +/- 1.6; 13.5 +/- 4.61 and 15.1 +/- 5.3 respectively. The corresponding figures for the duodenal ulcer patients was 3.2 +/- 2.7; 25.1 +/- 8.5; 28.4 +/- 11.1. P less than 0.05, P less than 0.001 and P less than 0.001 respectively). The mean stimulated gastric juice volume of 131.3 +/- 29.6 ml in the controls differed significantly from the volume 198.2 +/- 54.9 in the duodenal ulcer patients (P less than 0.001). 182 mls of gastric juice was found to be the volume above which is duodenal ulcer may be suspected. Acid values are compared with published data and reasons for any differences discussed.

Dose response studies of gastric acid secretion in Nigerians using pentagastrin stimulation.

To determine the does of pentagastrin required for maximal gastric acid secretion, 6, 8, and 10 micrograms/kg body weight of intramuscular pentagastrin were given to twenty Nigerian subjects (ten controls and ten duodenal ulcer patients). The different doses of pentagastrin were administered to each subject on different days. 8 micrograms/kg body weight of pentagastrin caused the highest gastric acid output in all the subjects followed by 6 and lastly 10 micrograms/kg body weight. Significant differences in the mean stimulated acid output by 6 and 8 micrograms/kg body weight to pentagastrin were found only in the duodenal ulcer patients (Maximal Acid Output (M.A.O.).

Small intestinal permeability in normal Sudanese subjects: evidence of tropical enteropathy.

Small intestinal permeability to mannitol and lactulose was studied in healthy English and apparently healthy Sudanese subjects to determine whether any differences were apparent. Permeability was assessed by measuring urinary recovery of the test substances after oral ingestion. The mean excretion of lactulose was significantly higher and the mean excretion of mannitol was significantly lower in the Sudanese than in the English subjects. Lactulose to mannitol excretion ratios were significantly higher in the Sudanese. These data demonstrate abnormal intestinal permeability in the Sudanese subjects and indicate the presence of an asymptomatic enteropathy.

Small intestinal permeability as an indicator of jejunal mucosal recovery in patients with celiac sprue on a gluten-free diet.

Lactulose/mannitol excretion ratios were measured in 13 patients with celiac disease at diagnosis and after 5-8 months on a gluten-free diet. Jejunal biopsies were assessed histologically at diagnosis and during treatment. The excretion ratios in untreated patients were significantly higher than in 25 normal controls (P less than 0.01). On the diet, the excretion ratios fell in every patient, but in only eight did the ratio return to normal. There was a good correlation between the ratio and jejunal histological grading. During treatment, the ratios significantly inversely correlated with jejunal villous height/mucosal thickness ratios (P less than 0.001). Therefore, excretion ratios provide a well-tolerated noninvasive means of assessing the jejunal mucosa in patients with celiac disease on a gluten-free diet.

Small intestinal permeability to mannitol, lactulose, and polyethylene glycol 400 in celiac disease.

Mannitol (molecular weight 182), lactulose (342), and polyethylene glycol 400 (range 242-550) absorption was studied in 25 controls, 22 untreated celiacs, and 13 treated celiacs. Untreated celiacs absorbed less mannitol and more lactulose than controls. Absorption of higher as well as lower molecular-weight polyethylene glycols was reduced in untreated celiac disease. Absorption returned towards normal on treatment. Polyethylene glycol and lactulose absorption was enhanced by administering them in a hypertonic solution. Polyethylene glycol 400 but not lactulose or mannitol was lipid soluble in vitro. It was concluded that the mucosa in untreated celiac disease was more "leaky" than normal. Polyethylene glycol 400 absorption data suggested that its absorption may largely be determined by its lipid solubility and was decreased in celiac disease because of the reduced surface area of the small intestine. Polyethylene glycol 400 cannot be recommended as a suitable marker for permeability studies of the small intestine.

Small intestinal permeability to sugars in patients with atopic eczema.

Absorption of lactulose and mannitol was measured in eleven patients with atopic eczema and lactulose/mannitol excretion ratios were calculated. Mean lactulose absorption was increased in the patients with exzema and their excretion ratios were higher than those of controls. There was no correlation between either eczema extent or severity and the excretion ratio. We conclude that small intestinal passive permeability is increased in some patients with atopic eczema.

Abnormal small intestinal permeability to sugars in patients with Crohn's disease of the terminal ileum and colon.

The absorption of lactulose and mannitol in 20 patients with Crohn's disease limited to the ileum or colon was studied, and lactulose/mannitol excretion ratios were calculated. The results were compared to those from 16 normal controls and 6 patients with ulcerative colitis. The 13 patients with ileal Crohn's disease had significantly higher lactulose/mannitol excretion ratios than the controls (p less than 0.01) or ulcerative colitics (p less than 0.01). Similarly, the 7 patients with Crohn's disease limited to the colon had significantly higher excretion ratios than the controls (p less than 0.01) or ulcerative colitics (p less than 0.01). The results provide support for the concept that Crohn's disease may be more extensive than is apparent macroscopically.

Serum lysozyme activity in coeliac disease: a possible aid to athe diagnosis of malignant change.

Serum lysozyme activities were measured in 34 control subjects, 13 untreated adult coeliac patients, 21 adult coeliac patients on gluten-free diet, and eight coeliac patients with a histiocytic lymphoma. Serum lysozyme activities were raised in three untreated patients, three patients treated with a gluten-free diet, and in only two patients with coeliac disease and lymphoma. Serum lysozyme estimations cannot be recommended as an aid to the diagnosis of lymphoma in patients with coeliac disease.