Esophageal endoprostheses are very useful in management of patients with esophageal cancer and are the primary therapy for patients with esophagorespiratory fistula. In addition, patients with tumors, poorly responsive to dilatation or other therapies, will have long-lasting symptomatic relief when an endoprosthesis is placed. The available prostheses are discussed, as well as the methods of insertion and the relative merits of each. The self- expanding metal stents may have advantages over plastic stents.

Two consecutive and matched groups of morbidly obese patients, i.e. group (1) and (2) were selected to be treated with Garren-Edward Bubble (18 patients) and the Danish-Ballobe (10 patients), respectively, and according to the American FDA criteria. All patients were put on 1000-1200 K. cal diet and given the choice to enrol in the behavior modification program (BMP) or not; (15) patients enrolled in it (group A) and (13) patients refused (group B). At the end of the treatment period (i.e. 3 months group 1; 4 months group 2) the mean loss in the body mass index (BMI) for group (1) and (2) were 5.46 ± 4.6 kg/m ² , and 3.98 ± 5.5 kg/m ² respectively. With insignificant statistical difference (P>1.0). While the mean loss in the BMI was 7.17 ± 4.54 kg/m ² and 1.85 ± 0.92 kg/m ² for group A & B respectively. With a very significant statistical difference (P<0.01). No major complication was noticed except that in two patients (group 1) and four patients (group 2), the ballon had to be removed within the first week of insertion due to intolerance. In conclusion, although both balloons are safe, they are weakly effective and the main effect could be attributed to the BMP.

Ulcerative Colitis is now being recognized amongst the Arabs. After consideration of the clinical, endoscopic and histopathological data, 80 Saudi patients out of 1,182, were diagnosed as ulcerative colitis. There were 47 males and 33 females. The age ranged between two and 90 years (mean 36.5 years). Endoscopically, the disease was limited to the rectum in 22.5%, rectum and sigmoid in 30%, extended up to the splenic flexure in 27.5% and beyond the splenic flexure in 20% of the patients. Our data supports the recent observation that ulcerative colitis is not uncommon in this part of the world. There are differences in the extent of disease and the presence of local complications, between our patients and those in the high incidence areas.

A study was undertaken to compare the usefulness of plain abdominal X-rays (PABR) and small bowel enema (SBE) in evaluating cases of clinically unclear small bowel obstruction. The PABR of the patients taken just before the small bowel enema were compared to the films of the SBE. Fifty-two out of 76 were eventually operated on. The results show the gross limitations of PABR in excluding the presence of small bowel obstruction. The sensitivity and negative predictive value of SBE in identifying or excluding obstruction were 100% each, while the corresponding values of PABR were 42 and 40%. However, the margin of specificity and positive predictive values were narrow; 94 and 97 percent in SBE and 86 and 88 in PABR. SBE was also superior in identifying the cause and location of obstruction. In conclusion, due to the specificity of PABR it will remain the first line of investigations in suspected intestinal obstruction. However, its limitation in excluding the presence of obstruction cannot be overemphasized. The SBE confirms or excludes obstruction promptly and should be applied as the most accurate evaluation.

Clinical evaluation and diagnostic paracentesis with estimation of the serum-ascitic albumin gradient (SAAG) is the most important step in identifying the etiology of ascites. At a level of 1.1 g/dl, SAAG, accurately (96.7%) differentiate portal hypertension from nonportal hypertension-associated ascites. The majority of patients with ascites (>80%) have portal hypertension associated etiology mainly, liver cirrhosis. Approximately 90% of patients with ascites complicating cirrhosis respond to salt restriction and diuretics. The remainder (10%),have refractory ascites which commonly respond well to large volume paracentesis (LVP). Asymptomatic complications occurring in patients treated with LVP may not necessitate treatment. Other alternative methods for treatment of refractory ascites include: ascitic fluid recirculation (AR), peritoneovenous shunting (PVS),transjugular intrahepatic portosystemic stent-shunting (TIPS) and orthotopic liver transplantation (OLT).

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.