Two hundred and twenty-four consecutive patients seen for the first time with symptomatic hemorrhoids were given a high fiber diet supplemented by ispaghula husk. Patients were seen at 1, 3, 6 and 12 months and showed improvement. The results suggest that conservative treatment using only a high fiber diet supplemented by Metamucil is highly effective in the symptomatic treatment of patients with piles.

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The objective is to present the usefulness of hepatobiliary scintigraphy in the investigation of children with suspected choledochal cysts through our experience in King Khalid University Hospital at King Saud University, Riyadh. Seven patients aged between I and 10 years (average 4.8 yrs) comprising six females and one male were investigated. Laboratory tests, abdominal Ultrasound and/or CT, and cholangiography were performed whenever indicated. Persistent activity in a dilated common bile duct, with or without dilatation of intrahepatic bile ducts, was considered a positive indicator for choledochal cyst disease. Four children with cystic dilatation (type I) were diagnosed by hepatobiliary scintigraphy, one saccular (type II), and two cases of Caroli's disease (type V). The diagnosis of choledochal cyst was proven by surgery with histological confirmation. Visualization of the gallbladder occurred in one case only. The common bile duct was seen in four cases. Late activity in the bowel was noted in two cases.

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Background -Risk factors for acquiring hepatitis C virus (HCV) infection have been elucidated in many developed countries but the picture is still not clear in many Middle Eastern Countries including Saudi Arabia. Aim -To investigate possible risk factors for acquiring HCV among Saudis. Methods -Various demographic and medical risk factors that might be associated with the spread of HCV among Saudis were investigated. The population studied included 20 anti-HCV-positive with chronic liver disease (CLD), 30 anti-HCV-positive patients without CLD and 272 anti-HCV-negative Saudi blood donors. All people investigated were of the same age group (>40 years of age). Results -None of the demographic parameters studied (type of job, type of housing, education) was found to be significantly associated with acquiring HCV infection among our Saudi patients. On the other hand up to 40% of the anti-HCV­positive patients and irrespective of the condition of liver disease had a history of surgery, and 25% of them had a history of multiple injections. Furthermore, at least 20% of our anti-HCV-positive patients had a history of schistosomiasis which is significantly higher than schistosomiasis among the blood donors (P<0.005). Conclusion -In addition to blood and blood products, schistosomiasis seems to be a possible risk factor for acquiring HCV among the Saudi population. The association between schistosomiasis and enhancement of HCV infection need to be further elucidated.

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Esophageal varices develop in 30-70% of patients with liver cirrhosis. One-third of these varices will eventually bleed and first episode could be fatal in 40-50% of patients. Because of this, primary prophylaxis can be justified if patients at high risk of bleeding can be identified. Many endoscopic findings can identify the patients likely to bleed in near future. The results of primary prophylaxis with portacaval shunts and endoscopic sclerotherapy have been disappointing. Nonselective betablockers have been found effective in preventing bleeding from varices and their use is justified for this purpose.

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In a study of 27 cases of perforated duodenal ulcer seen at Asir Central Hospital over a period of seven years, two patients were females and 25 males. The highest incidence was in the fourth decade and the average age was 36.3 years. The Saudi-foreigner ratio was 1:2.9 in an area where the Saudi-foreigner population ratio was 1:3. Nine patients (33.3%) were previously diagnosed as having peptic ulcer and had received treatment at one time or the other before perforation. Eighteen patients (66.7%) were first diagnosed to peptic ulcer after the perforation. All the identified perforations were located anteriorly and anterosuperiorly. Only one case occurred in the second part of duodenum. The rest occurred in the first part. Two patients were treated successfully conservatively. The month perforations occurred most was the month of Shaaban. The fasting period during the month of Ramadhan did not show any increase in the prevalence of perforation in this hospital.

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Pediatric liver transplantation has become a widely accepted therapy for children with end-stage liver disease. The objectives of this article are to review the development of liver transplantation in children, provide an overview of indications and complications, examine some of the exciting technical advances made over the last decade that have improved donor organ availability for children, look at some of the technical problems that still need to be solved, discuss current outcomes and outline new directions of research.

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This is a prospective study of life event stress in 80 duodenal ulcer patients compared with 80 patients with functional dyspepsia and 80 healthy controls; matched for age, sex and marital status. A semi structured psychiatric interview was used in the psychiatric assessment of the dyspeptic patients and controls. A modified version of Life Events Scale by Tennant and Andrews was used in the assessment of life event stress. More dyspeptic patients reported life events than the controls, but, on the whole, the differences were not statistically significant. On the other hand, more patients with functional dyspepsia experienced life events than the patients with duodenal ulcer, but again the results were not consistent. Life event stress as measured by the experience of undesirable life events was significantly reported by more patients with functional dyspepsia. The significance of the presence of life events in duodenal ulcer and functional dyspepsia patients is not substantiated in the present study, as the positive findings were few and sometimes inconsistent. More quantitative studies are needed, taking into consideration the other aspects of the problem like personality, cognition and the complex interaction of stressors and personality.

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