Background: Hepatitis C Virus (HCV) infection is a common universal problem especially in the Arab World. Objective: To assess the significance of persistently normal liver enzymes in patients who were anti HCV positive and suggest the proper approach for this group of patients. Method: 56 patients who were anti HCV positive with persistently normal liver enzymes for more than one year underwent liver biopsy to assess their liver histology after excluding other possible causes of chronic liver disease. METAVIR scoring system was used and the degree of fibrosis (F0-F4) was considered as reflection of severity. Results: Out of 56 patients, only 52 patients had liver biopsies; 44 (84.6%) patients had abnormal liver histology and eight (15.4%) patients had normal liver biopsy. Out of the 44 patients with abnormal liver biopsy, 23 (44.2%) patients had mild histology (F1-F2); 15 (28.8%) patients had severe histology (F3); two (3.8%) patients had cirrhosis (F4); four (7.7%) patients had non-specific changes (Al/FO). Conclusion: Normal liver enzymes in patients who were anti HCV positive does not carry prognostic implication and patients should have a liver biopsy to assess their liver histology, though the chance of having mild histology with minimal inflammation is more than 50%.

Background: Financial constraints and pressing priorities are major problems that delay implementation of laparoscopic cholecystectomy (LC) in some countries. This raised the need for improvisation and innovation ^[1],[2] . Endoclips are not available in some local markets. They cost $50 for a single set of six clips to import, in contrast to 2/0 polyglacin (Vicryl-Ethicon), which is available at a rate of $1.5 for one thread. Objective of the study: To compare the safety and cost between vicryl ligature and endoclips. Patients and Method: To secure the cystic duct, intracorporeal vicryl ligature (IVL) was applied in 64 LCs. These were divided into 32 patients presented with cystic duct, which was too wide to controlled with endoclips (group A) and 32 patients with normal diameter of cystic duct as controls (group B). Also we describe the test we used to prove the safety of IVL in the two groups. This ligature was tested with high pressure introduced and measured into the gallbladder by sphygmomanometer. Results: The gallbladder can withstand a mean (+ SD) pressure of 197 (+20.94)mmHg and 191.67 (+10.2) in group A and B respectively without statistically significant difference (P 0.1305). Total cost of vicryl was $128 compared to $3200 if endoclips were used. No complication was noted related to these ligatures in a period of two year-follow up. Conclusion: This method is easy, cost effective and suitable in some countries.

Background: After endoscopic therapy for peptic ulcer bleeding, rebleeding occurs in up to 20% of patients. Objective: The aim of this retrospective analysis was to identify the factors responsible for failure to achieve hemostasis or rebleeding after endoscopic therapy. Methods: Seventy six patients who bled from peptic ulcers and received endoscopic therapy were identified in a retrospective analysis of six years, from 1993 to 1998, in a tertiary care hospital in Muscat, Oman. All patients were endoscoped within 24 hours and received endoscopic treatment, either injection of 1/10,000 adrenaline alone or both injection and thermocoagulation. We looked at the following factors, which could have influenced the outcome of endoscopic therapy. The clinical and endoscopic parameters used to assess the outcome of endoscopic therapy were: age, sex, blood pressure and hemoglobin on admission, number of units of blood transfused , use of NSAID, comorbid conditions, ulcer site, ulcer size. Forrest grade, injection alone and injection plus thermocoagulation. Results: Endoscopic therapy failed in 16 patients (21%). Twelve patients received a second endoscopic treatment , but 13 patients eventually required surgery. Six patients died as a result of bleeding (mortality 8%). Among the parameters, hemoglobin on admission, more than six units of blood transfusion, shock, co-morbid diseases, ulcer site and size and Forrest grade la predicted the possibility of failure of endoscopic therapy. Conclusion: In patients presenting with peptic ulcer bleeding, hemoglobin less than 10 grams, more than six units of blood transfusion, shock on admission, co-morbid disease, posterior wall duodenal ulcer, large ulcer size of > I cm size and Forrest la predicted failure of endoscopic therapy.