α₁ ,-antitrypsin (α₁ AT) deficiency is a relatively common genetic cause of liver disease among Caucasians. It is an autosomal recessive disorder characterized by reduced serum levels of α₁ AT, a 52-kD glycoprotein that functions as an antiprotease. The deficiency state is caused by mutations in the α₁ AT gene on chromosome 14. α₁ AT shows considerable genetic variability, having more than 75 genetic variants (Pi types). The PiZ allele is the most common deficiency variant. PiZZ homozygotes have 15-20% of the normal plasma levels of α₁ AT. The deficiency is due to lack of secretion of Z α₁ AT from the hepatocyte, where inclusions are formed in the endoplasmic reticulum. Homozygous α₁ AT deficiency (PiZZ) is known to predispose to emphysema and chronic liver disease. This review outlines the clinical manifestations and treatment of α₁ AT deficiency associated liver disease, focusing on recent advances in the pathogenic mechanism of liver disease in this genetic disorder.

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.

Lymphoid tissue is normally absent in the gastric mucosa; however, lymphoid follicles are very frequently noted in Helicobacter-associated gastritis. We reviewed 237 cases of chronic gastritis with lymphoid follicles. Out of this 227 cases (95.8%) were found to have H. pylori infection. The significance of this finding and its possible relationship to primary gastric lymphoma are discussed.

This is a prospective study of the psychiatric morbidity in 80 patients with duodenal ulcer, 80 with functional dyspepsia and 80 healthy controls; matched for age, sex and marital status. A semi structured psychiatric interview and clinical mental state examination were used in the psychiatric assessment of the patients and controls. Psychiatric diagnoses were made according to DSM3-R. A modified version of Life Events Scale by Tennant and Andrews was used in the assessment of life events in relation to psychiatric illness. Psychiatric illness was significantly more in the patients than the controls. Anxiety and depressive disorders dominated the clinical picture and the symptoms were usually of mild nature. Other neurotic were rare and psychotic illness was absent. Though more psychiatric patients experienced life events than the controls, differences, however were not statistically significant. Further studies are needed, especially in relation to the causative association between the functional dyspepsia and psychiatric disturbances.

The objective of this study is to describe the normal, abdominal radiological findings after laparoscopic cholecystectomy that could be confused with a pathological process. Thirty-one patients, who had laparoscopic cholecystectomy were prospectively studied. They underwent supine and erect abdominal X-rays, on the first and second postoperative days. In 19 patients (61 %) no residual free intraperitoneal gas was seen. In 12 patients (39%) small amounts of free gas were noticed 24 hours postoperatively, and in six (19%), some free intraperitoneal gas was seen after 48 hours. Distention of the colon was noticed in 17 (55%), and was mainly in the hepatic flexure area in nine of these patients (29%). Eight patients complained of shoulder pain. This study shows that pneumoperitoneum tends to disappear within 48 hours of laparoscopic cholecystectomy. When present, there is usually no cause for alarm as long as patients show no evidence of clinical disturbance.

Objective: To evaluate the diagnostic accuracy of ^99m Tc-red blood cell scintigraphy in the diagnosis of hepatic cavernous hemangiomas. Patients and Methods: Sixty three patients, 56 females (89%) and 7 males (1 I%), with ages between 22 and 54 years (median 33 years) were investigated for liver masses found on ultrasonography of the abdomen. All the patients had undergone ^99m Tc-liver-spleen scan followed by ^99m Tc-red blood cells scintigraphy. The size of the lesions ranged between 3 and 9 cm. The final diagnosis was reached through cytology, and/or histopathology or follow up for more than 3 years. Results: A total of 70 lesions were found as a single lesion in 60 patients and multiple (i.e. total of 10 lesions) in the other 3 patients. The results of ^99m Tc-red blood cells scintigraphy, compared to the results of the final diagnosis, showed sensitivity and specificity rates of 100% and 89% respectively, positive and negative predictive values of 98% and 100% repectively, and accuracy rate of 98.6%. A single false positive case was a hepatocellular carcinoma. Conclusion: ^99m Tc- red blood cell scintigraphy is highly accurate in the diagnosis of liver cavernous hemangioma and should characterize liver mass found on ultrasonography and suspected for hemangioma.