Invasion of the Ascaris worm into the biliary system leads to a wide variety of clinical syndromes. Most of the descriptions of the disease have originated from the developing world, where due to the environmental factors there is a high level of parasitism. An increased incidence of biliary ascariasis borne out of population migration and increased facilities for diagnosis has led to a renewal of interest in this disease in the developed world. Significant morbidity and mortality is associated with the concomitant complications, and early diagnosis and management is of utmost importance. Common disease presentations include biliary colic, obstructive jaundice, acalculous cholecystitis, choledocholithiasis, pancreatitis, and cholangitis. Although with a potential for serious mortality, pancreatitis, and cholangiocarcinoma constitute relatively less common threats. Recent advances in endoscopy have shifted the attention of this disease from the surgeon to the gastroenterologist and a consensus of opinion is arising for early intervention. We present here a patient with biliary ascariasis managed endoscopically and review the epidemiology, prevalence, clinical presentation, diagnosis, and management of this disease.

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The application of opto-electronic in video-endoscopes aims to improve accuracy in diagnosis, through image processing and digital technology. Narrow band imaging (NBI), one of the most recent techniques, consists of using interference filters for the illumination of the target in narrowed red, green, and blue (R/G/B) bands of the spectrum. This results in different images at distinct levels in the mucosa and increases the contrast of the epithelial surface and of the subjacent vascular network. NBI is combined to magnifying endoscopy with an optical zoom. After being studied in prototypes the opto-electronic technique, now available in the most recent models of video-endoscopes that use the sequential R/G/B system of illumination, should be adapted in the near future for the instruments utilizing the non-sequential system of illumination. This new technique aims to characterize the surface of the distinct types of digestive epithelia, including intestinal metaplasia in the Barrett's esophagus. The technique also allows characterizing the disorganization of the vascular pattern in inflammatory disorders of the digestive mucosa and in superficial neoplastic lesions in the esophagus, stomach, and large bowel.

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Gallstone ileus is an uncommon complication of cholelithiasis, with a high morbidity and mortality rate - usually related to the delayed diagnosis of intestinal obstruction. Diagnosing gallstone ileus needs a high index of suspicion. A case of a gallstone ileus is reported. The clinical presentation, radiological features, intraoperative findings, operative procedure and literature review are presented.

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When the clinical features strongly suggest the presence of bile duct stones, management is fairly straightforward; diagnostic and therapeutic endoscopic retrograde cholangiography (ERC) may in some cases constitute the entire strategy. Unfortunately, the clinical picture is often equivocal or uncertain. Although stones are unlikely to be present in the bile duct when the clinical index of suspicion is low, their presence can never be completely ruled out based on clinical and biochemical parameters. Thus, an accurate, noninvasive, reliable, and safe method for bile duct imaging would be highly advantageous. Low-risk tests, such as endoscopic ultrasound (EUS), are emerging as reliable substitutes for diagnostic ERC. This review highlights the technical aspects of examining the extra-hepatic biliary duct system and the performance and results of EUS in diagnosing patients who present with possible common bile duct stones.

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Aim: To assess the effect of Linoleic acid and oleic acid on gastric lesions induced by ischemia reperfusion. Materials and Methods: Twenty-six fasted rats were subjected to 30 minutes of gastric ischemia in the presence of 100 mmol/L hydrochloric acid and reperfusion periods of 60 minutes. The vascular permeability was quantified by measuring the extravasated Evans blue in the stomach. Results: There were greater amount of leakage of Evans blue in gastric mucosa of rats treated with linoleic acid as compared to the control. Evans blue levels were significantly higher in gastric fluid as compared to the control. In contrast, Oleic acid significantly reduced the leakage of Evans blue in the gastric mucosa. Conclusion: Oleic acid played a significant role in protecting the gastric mucosa from ischemia/reperfusion injury. Replacement of LA by OA in the diet could be beneficial in protecting the gastric mucosa.

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A helminthoma is an inflammatory tumor of the bowel wall, which results when an intestinal worm or larva penetrates the wall of the gut, usually the cecum or colon. A helminthoma can occur in any country where infestation of the intestinal tract with worms is common. It has been seen most often in West and East Africa and parts of South America. In some parts of West Africa, this disease is well known to villagers, who describe it as having 'a turtle in the belly.' We report such a case with diagnostic dilemma.

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Background: Hepatocellular carcinoma (HCC) is the second commonest cancer affecting males and the eighth most common one affecting females in Saudi Arabia. Transarterial chemoembolization (TACE) is currently considered the first line therapy for multifocal HCC in selected patients. Objective: To evaluate HCC response to TACE based on triphasic computerized tomography (CT) of the liver obtained 6 weeks after the procedure. Materials and Methods: A retrospective chart review of 15 patients who underwent TACE in King Khalid University Hospital for unresectable HCC. Patients were staged according to the Child-Pugh, Okuda, and CLIP scoring systems. The first triphasic CT of the liver after TACE was evaluated for Lipiodol uptake and interval change in tumor burden. Results: The mean age was 63 years (40-82), 10 were males (66.7%), and five were females. About 11 patients had cirrhosis (73.3%). Eight patients (53.3%) were Child-Pugh class A while seven (46.7%) were Child-Pugh class B. One patient died and two were lost to follow up. Four patients had a complete response to TACE (26.7%), two had a partial response (13.3%), five showed no change (33.3%) and none showed progression of disease. Tumoral Lipiodol uptake in five patients was >75% (33.3%), in two 75-50% (13.3%) while in four patients it was <50% (26.7%). Conclusion: Our results show that TACE is an effective method of reducing the tumor burden in selected patients with unresectable HCC.

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Inflammatory bowel disease (IBD) has gained immense attention recently due primarily to increasing prevalence. The exact disease mechanism is still unknown. There is considerable evidence of interrelation between the mechanisms of angiogenesis and the chronic inflammation of IBD. This evidence was obtained from animal models of colitis and confirmed in human studies. Serum levels of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (b-FGF) have been found to be significantly higher in patients with IBD than in controls. In addition, it was found that these factors correlate well with disease activity and decrease with the use of steroids. Therefore pharmacological inhibition of angiogenesis has the potential to be a therapeutic strategy in IBD.

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