Alpha 1-antitrypsin (αl AT), a serpine, is one of the most important proteinase inhibitor in the serum and plays an essential role in protection of the lung tissues against the proteolytic attach of elastase. The gene for a1AT is located on chromosome 14 q 32 and is highly susceptible to mutations. A large number of variants of α 1 AT are known and some including PiZ and PiS result in a1AT deficiency. In patients with PiZ, the most severe and common α1AT deficient variant, the α1AT protein accumulates in the liver and results in severe hepatic diseases. Other clinical consequences of α1AT deficiency include emphysema in majority of the patients. This state is further aggravated in patients who smoke. Several treatment strategies have been suggested, including replacement therapy by purified α1AT or recombinant α1AT given intravenously or as aerosol. Synthetic peptides. lung transplantation and volume reduction surgery are under investigation and evaluation. This paper updates the information on α1 AT and its deficiency state.

This is a review on the updated terminology of chronic hepatitis, a topic that has gained much popularity in the current literature of gastroenterology. The aim of this review is to familiarize readers with its use and to discourage the old terminology. The new terminology of chronic hepatitis takes into consideration etiology, severity (grade) and degree of chronicity measured by fibrosis (stage). The use of the new terminology would standardize our diagnosis with the aim of standardizing therapeutic modalities for the purpose of reproducibility of results.

The objective is to study the Postcholecystectomy Syndrome (PCS); its causes, different methods of diagnosis and different treatment options and their results in order to deduce from the above data the best method of prevention of its occurrence and the best method of treatment once it has occurred. Data sources include a medline search of articles covering this topic in the English literature and the abstracts of non-English articles from 1966-1994. The total number of articles of interest to the study being approximately 120. There are many causes of PCS, some related to improper preoperative diagnosis and some related to avoidable and unavoidable consequences of cholecystectomy. The different diagnostic modalities are dependent on the cause as are the different treatment options. The best treatment of this condition remains prevention whenever possible. Proper diagnosis of those patients who truly require cholecystectomy and care in performing the cholecystectomy will minimize the incidence of this syndrome.

The objective is to analyze the experience of using diagnostic and therapeutic ERCP and to attempt identifying the independent factors that predict positive and useful procedures. The medical records of 198 patients seen during the period 1991-1993 were retrospectively reviewed. There were 102 males and 96 females with a mean age of 45.2 SD + 16.7 years. The main indications for performing the procedure were jaundice, abdominal pain, nausea and/or fever. Laboratory tests showed elevated direct bilirubin in 50% of patients, deranged liver enzymes in 43%, and ESR was raised in 51% and fever was documented in 52% of patients. The cannulation of both ducts was successful in 93% of all procedures. The commonest finding was gallbladder and common bile duct stones (CBD). In 54 patients out of 64 with CBD stones, stones were removed endoscopically. Stepwise regressive analyzis has identified age above 40 years, presence of jaundice (total bilirubin > 2.5 mg/ml) and raised ESR (> 25 mm in the 1st hour) as significant factors that independently predict a positive ERCP that revealed findings previously unknown (useful procedure). Diagnostic and therapeutic ERCP is an integral part in management of biliary and pancreatic ducts disorders. The validity of clinical prediction role should be tested prospectively.

Acute gallbladder perforation, an infrequent though not uncommon complication of Cholelithiasis and acalculus cholecystitis is reviewed using as materials 16 Arab patients (6 males and 10 females; one Egyptian and 15 Saudis) with gallbladder perforation among 952 patients who had undergone cholecystectomy in Asir Central Hospital between 1990 and 1994. The presentation, method of diagnosis and treatment modalities are compared with recent literature review findings. Since cholecystitis (calculus and acalculus) is a common pathology in Saudi Arabia a preoperative awareness of this complication of the disease will improve diagnosis and minimize morbidity and mortality of gallbladder perforation.

One hundred and fifty-two consecutive cases of cholelithiasis were studied. The gallbladder stones were analyzed to determine the constituents, the bile specimens were cultured and correlated with the cultures when wound infection occurred . Mixed gallstones were the commonest type (58.5%), pigment stones (27%) and cholesterol stones (14.5%). Positive bile cultures were found in 41 patients (27%) and Escherichia coli was the commonest organism isolated. The rate of wound infection was 14.5% and the most common organism cultured from the wound was staphylococcus epidermidis.

In this report we present our experience with 12 cases of Crohn's disease out of 1279 consecutive colorectal biopsies (0.9%), seen during an l 1 years period (1983-1994) in a tertiary care teaching hospital. During the period 76 cases (6%) of Ulcerative Colitis (UC) were seen. Of the 12 patients with Crohn's disease, seven were males and five were females, all Saudi nationals aged 16-39 with a median of 23 years, relatively younger than those with UC seen during the same period. Recurrent colicky abdominal pain was the striking presenting symptoms in all patients, commonly associated with weight loss. The disease involved both small and large bowel in eight patients (67%) and the colon alone in one patient. Granulomas were seen in seven patients (58%). Surgery was offered for two patients and most of the remaining patients were symptomatic on follow up.