The past few years have witnessed a tremendous progress in our knowledge regarding the pathogenesis, diagnosis, prognostic evaluation and classification of acute pancreatitis. The role of ischemia, lysosomal enzymes, oxygen free radicals, polymorphnuclear cells-byproducts and inflammatory mediators in the pathogenesis of pancreatic necrosis and multiple organ failure has been emphasized. Furthermore, the recent knowledge about agents infecting pancreatic necrosis, routes of infection, bacteriological examination of fine needle aspirate and appropriate antibiotics have changed the concept of acute pancreatitis. New diagnostic tests such as rapid urinary trypsinogen-2 test and inflammatory mediators including polymorphnuclear elastase, C-reactive protein and interleukin-6 contribute to early diagnosis, prognostic evaluation and initiation of an appropriate therapy.

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The radiological features in barium gastrointestinal studies and computed tomographic (CT) examinations of 22 consecutive cases of proven peritoneal and/or intestinal tuberculosis were analyzed in order to highlight the radiological features which could provide ready identification of the disease. There were 15 cases of intestinal tuberculosis and 7 cases of peritoneal tuberculosis and 3 patients had both. The commonest location of intestinal tuberculosis was the ileocecal region (N=10) which occurred in association with colonic or ilea] disease. Bowel wall thickening in CT was largely asymmetrical but minimal and symmetrical wall thickening occurred with peritonitis. Luminal narrowing with or without mucosal tethering were seen in both CT and Barium studies. Peritoneal TB had either high density ascites with smudge or nodular omental surface with a thickened omental lining. Also detected was fibrinous dry peritonitis with thickened mesenteric tissue. Lymphadenopathy in the peripancreatic, mesenteric or paracaval were common to both intestinal or peritoneal tuberculosis (21 out of 22). Fifty percent of the patients showed some lymph nodes with necrotic centers. The differential diagnosis included malignant peritonitis and intestinal or mesenteric carcinoid. The study shows that a combination of barium gastrointestinal study and computed tomography can provide distinct features which could strongly suggest the diagnosis of intestinal or peritoneal tuberculosis.

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To evaluate the pattern of Helicobacter pylori ( H. pylori ) susceptibility to different antimicrobial agents, we prospectively studied 45 H. pylori isolates by disc diffusion method. These isolates were obtained from patients aged between 16-75 years, of both sexes who had no prior history of metronidazole ingestion. A total of 45 patients were included, of which 36 were males with a mean age of 42.9 years and nine females with a mean age of 36.4 years, 62% of patients were Saudis. Almost all the H. pylori isolates were susceptible to clarithromycin, penicillin, erythromycin, ampicillin, tetracycline, clindamycin and cephradine. However, 64.4% of the isolates were resistant to metronidazole. No significant difference was found either in susceptibility of isolates from Saudi, non-Saudi or male and female patients.

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In a six-year period, starting from the commissioning of Asir Central Hospital in 1408 H (1988), 43 cases of hydatid cyst disease caused by echinococcus granulosus seen in Asir Central Hospital were studied. The pattern was not significantly different from other workers' experiences. There was equal sex distribution and the average age was 41.7 years. The clinical presentations depended essentially on the organs affected, and computed tomography usually confirmed the diagnosis. The serological test at times gave a false negative result. Most of the patients came from Abha in Asir region and the most commonly involved organ was the right lobe of the liver. All the patients had laparotomy, excision or incision and drainage of the cyst, depending on whether the cyst could be safely excised or only drained. The average hospital stay was 17 days. We believe that surgical intervention should be the first line of treatment especially when the cyst is large.

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Recent studies have shown that selenium afforded protection against ethanol and stress-induced gastric lesions in rats. The present study was undertaken to investigate the effect of selenium on ischemia-reperfusion-induced gastric injuries in which rats were subjected to 30 minutes of ischemia in the presence of 100 mM HCI and a reperfusion for 60 minutes duration. Intraluminal bleeding was assessed macroscopically and gastric lesions were graded microscopically under an inverted microscope. Nonprotein sulphydryl levels were measured spectrophotometrically. The severity of gastric lesions, intraluminal bleeding as well as the depletion of nonprotein sulphydryls during the reperfusion periods was significantly different from that of control. Pretreatment with selenium (0.125-2.0 mg/kg, intraperitoneally) 30 minutes before the ischemia-reperfusion, dose-dependently attenuated the gastric lesions, reduced the severity of intraluminal bleeding and prevented the depletion of nonprotein sulphydryls in the stomach. These results suggest that the gastric protection effect of selenium may be due to its antioxidant properties. Furthermore, endogenous nonprotein sulphydryls may play a significant role in the protective mechanisms of selenium.

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The objective is to compare the endoscopic findings before and after initiation of open access and its effect on gastrointestinal radiology services. The data of endoscopic findings before open access endoscopy (July, 1989-June, 1992) and after open access endoscopy (July, 1992-June, 1995) was collected from the records of the endoscopy unit. Similarly, data of barium meals for the same periods was collected from the radiology department. An X ² test was used to compare the endoscopic findings before and after open access policy. It is found that open access endoscopy increased the workload in the endoscopy unit but at the same time reduced the number of gastrointestinal radiological procedures. It reduced the waiting period for endoscopy and this helped in making early diagnosis and initiation of appropriate treatment.

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Every academic scientist will come into contact with peer review process either as a reviewer of others work, or as an author whose work is being reviewed by others, or as an applicant for research grant. Historically, peer review process came at various times to various journals for a variety of reasons in haphazard manner. Many forms of criticisms have been made against the process of peer review, and some critics do not believe that the process prevents the publication of flawed articles and fraudulent research. Despite the criticisms, there are advantages of peer review. At present in medical journalism peer review process is an indispensable entity for assessing manuscripts intended for publication.

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