Somatostatin is found in the pancreas and gastrointestinal tract, including the visceral autonomic nervous system, the endocrine D cells and the gut lumen. Somatostatin peptides may act differently at different sites as hormones, as paracrine substances or neurotransmitters. So far not much is known on the physiological effects of somatostatin in the gastrointestinal tract. Somatostatin and octreotide, a synthetic analogue with a longer half-life and higher potency, inhibit the neuroendocrine and exocrine gastrointestinal secretion, intestinal glucose, fat and amino acid transport, intestinal propulsive and gallbladder motility, splanchnic blood flow in volunteers and hepatic venous pressure in cirrhotic patients. The inhibition occurs to various extents depending on the target organ. This review deals with the pharmacological effects of octreotide on different gastrointestinal functions and describes the therapeutic role in different gastrointestinal disorders.

The hydroxy derivative of metronidazole can exhibit equal or greater activity to the parent drug against several bacteria. The susceptibility status of 22 H. pylori strains to these breakdown compounds was determined in order to determine their possible role in the therapy of H. pylori associated peptic ulcer disease. The susceptibility was determined using the agar dilution method and substantial activity (MIC90 = 0.33 .tg/ml) for the hydroxy metabolite of metronidazole versus H. pylori was observed. The findings define a role for the hydroxy derivative of metronidazole in peptic ulcer disease and support the limited data on the possibility of cooperative interactions between the parent compound, its main derivatives and related companion drugs in this condition.

This is a study performed to identify the risk factors for gallstones in Saudis, taking the patient population of King Khalid University Hospital as a sample. Only Saudis with symptomatic gallstones were studied, the parameters being age, sex, weight, body mass index, fertility, age at menarche and age at marriage. The results showed that sex, weight, body mass index and fertility all appeared to be important factors in the development of gallstones and that the condition affects more Saudi females and at a younger age than reported in the literature, probably due to overweight and factors related to reproductivity. We conclude that gallstones are common in Saudi women and affect them at a younger age than western women, weight and fertility appear to be important risk factors.

One hundred and eight patients with histopathologically confirmed acute cholecystitis underwent laparoscopic or attempted laparoscopic cholecystectomy in the Security Forces Hospital, from October 1991 to April 1996 were retrospectively reviewed. All the patients had routine laboratory works including abdominal ultrasonography. Females represented 75% and 57% had previous admission. Diabetes mellitus was found in 43.5%. Laparoscopic cholecystectomy was successfully completed in 71.2%. The main reasons for conversion in 31 patients were adhesions and unclear anatomy in 87%. The mean operative time was 96 minutes. Laparoscopic cholecystectomy for acute cholecystitis can be a safe and effective alternative to open cholecystectomy provided a safe dissection of the ductal and vascular anatomy with liberal attitude towards conversion is adopted. Patients presenting with leukocytosis >15,000/mm³, mass or diabetes are the most likely to be converted to open surgery.

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.

The present study was undertaken to determine the incidence of malnutrition among hospitalized patients. A cross-sectional study of patients were evaluated for findings suggestive of protein calorie malnutrition (PCM). Hundred and sixty patients admitted to the medical and surgical wards over a period of five months were studied. Anthropometrics and biochemical measurements were used. Nutrition status was calculated based on some nutrition parameters weight for height, midarm, circumference, serum albumin and total lymphocyte count. Anthropometric measurements, weight for height and midarm circumference reflected malnutrition (PCM) of 33.8% and 30% respectively. The overall prevalence of obesity was 21%. A higher proportion (23.9%) of medical cases were found to be obese compared to surgical cases (19.7%). If malnutrition can be documented on hospital admission, attempts can be made to reverse malnutrition in the high risk patients.