Background/Aim : Since selective screening for Hepatitis B virus (HBV) in pregnant women has failed to identify a high proportion of HBV-infected mothers, pre-natal HBsAg testing of all pregnant women is now recommended. We aimed to determine the prevalence of HBV infection among pregnant women at the ante-natal clinic of a tertiary care center in Saudi Arabia and to identify the target group for postpartum immunization. Materials and Methods : A total of 755 pregnant females who attended the antenatal clinic from June 2005 to June 2006 for the first time - before 38 weeks of gestation - constituted the target of the present study. Blood samples 30-39 were drawn from all subjects and sera were tested for HBV serologic markers including Hepatitis B surface antigen, anti-HBs, and anti-HBc using ELISA technique (third generation). Results : The overall prevalence of sero-positive HBsAg among pregnant women was 1.6%. As age increased, the prevalence of sero-positive HBsAg significantly increased (χ² = 116.43, P < 0.001), 30-39 were women aged ≥40 were five times more likely to be positive for HBsAg as compared to those <30 years (OR = 4.78). On the other hand, women aged 40 and over were five times more likely to be susceptible to infection with hepatitis as compared to young women aged <20 (OR = 5.15). Women susceptible to HBV infection constituted about 80% of all pregnant females. Conclusion : These findings reflect that the full impact of the Hepatitis B vaccination program that was conducted in 1989 for all Saudi children has not yet reached all pregnant women, with the majority (79.9%) being nonimmune and thus liable to HBV infection. Postpartum HB immunization should be recommended in such cases.

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Background/Aim: Previous studies regarding the outcome of laparoscopic cholecystectomy (LC) in men have reported inconsistent findings. We conducted this prospective study to test the hypothesis that the outcome of LC is worse in men than women. Materials and Methods: Between 1997 and 2002, a total of 391 consecutive LCs were performed by a single surgeon at King Fahd Hospital of the University. We collected and analyzed data including age, gender, body mass index (kg/m ² ), the American Society of Anesthesiologists (ASA) class, mode of admission (elective or emergency), indication for LC (chronic or acute cholecystitis [AC]), comorbid disease, previous abdominal surgery, conversion to open cholecystectomy, complications, operation time, and length of postoperative hospital stay. Results: Bivariate analysis showed that both genders were matched for age, ASA class and mode of admission. The incidences of AC ( P = 0.003) and comorbid disease ( P = 0.031) were significantly higher in men. Women were significantly more obese than men ( P < 0.001) and had a higher incidence of previous abdominal surgery ( P = 0.017). There were no statistical differences between genders with regard to rates of conversion ( P = 0.372) and complications ( P = 0.647) and operation time ( P = 0.063). The postoperative stay was significantly longer in men than women ( P = 0.001). Logistic regression analysis showed that male gender was not an independent predictor of conversion (Odds ratio [OR] = 0.37 and P = 0.43) or complications (OR = 0.42, P = 0.42). Linear regression analysis showed that male gender was not an independent predictor of the operation time, but was associated with a longer postoperative stay ( P = 0.02). Conclusion: Male gender is not an independent risk factor for satisfactory outcome of LC in the experience of a single surgeon.

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Neurofibromatosis type-1 (NF1), also known as von Recklinghausen disease, is a common autosomal dominant condition with an approximate incidence of one per 3000 births. NF1 involves multiple systems of the body. Abdominal involvement occurs in the form of neurofibroma and tumour growth in the liver, mesentery, retroperitoneum, gastric and bowel. Gastrointestinal neoplasms have a reported occurrence of 2-25%. Two cases are reported herein as well as a review of the literature of the intra-abdominal manifestations of NF1, including a discussion on the radiological appearance and diagnosis. The article provides an insight into the intriguing variety of clinical problems that such patients may present.

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Background/Aim: This retrospective study assessed the efficacy, safety, and the predictors of sustained viral response (SVR) to a 48-week-course of peginterferon α-2a (Pegasys) and ribavirin combination therapy in 335 consecutive Saudi patients with chronic hepatitis C virus (HCV) infection. Materials and Methods: Clinical, biochemical, and virological parameters were collected at time 0 (pretreatment) and at 12, 24, 48, and 72 weeks posttreatment. The mean ± SD age was 49.1 ± 13.0 years; 229 (68.4%) were males, mean ± SD body mass index was 27.8 ± 7.4, 85 (25.4%) were diabetic, 25 (7.5%) had renal impairment, 136 (40.6%) had previously received interferon ± ribavirin therapy, and 247 (73.7%) underwent pretreatment liver biopsy. Patients with genotypes 1, 2 or 3, 4 and mixed genotype were 60 (22.15%), 30 (11.0%), 148 (54.4%), and 34 (12.5%), respectively. Results: Early viral response (≥2-log10 HCV-RNA decline 12 weeks posttreatment) was achieved in 253 (75.3%). Patients who completed 48 weeks of treatment were 292 (87.1%); of these, 121 (75.6%) achieved ETVR, 161 (55.1%) continued to have SVR and 60 (20.5%) had a viral relapse following end-of-treatment response, that is 48.1 and 17.9% of all patients (n = 335), respectively. Nonresponders (NR) were 71 (24.3%) patients and 43 (12.8%) were unable to complete treatment (due to side effects or loss to follow up). Compared to the relapsers, patients with SVR were significantly younger ( P = 0.000), nondiabetics ( P = 0.015), had higher serum albumin ( P = 0.007), had less pretreatment inflammatory grade ( P = 0.011), infected with genotypes 2 or 3 ( P = 0.014), and treatment-naοve patients ( P = 0.001). However, in stepwise multivariate logistic regression analysis, only treatment naivetι and low pretreatment inflammatory score were the independent predictors of SVR ( P = 0.005 and P = 0.018, respectively). Conclusion: Combination therapy, if tolerated and completed, is effective in treating chronic HCV patients, especially those with no previous interferon therapy and lower pretreatment inflammatory grade.

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A small percentage of patients with hepatocellular carcinoma (HCC) are candidates for curative treatment in form of resection or transplantation. There are different treatment options for unresectable HCC-like local ablative therapies and recently systemic therapy with Sorafenib. All of these have variable response rate and had been proven to improve survival. In the last few years, there is a growing interest in TheraSphere radioembolization. It consists of yttrium90 (Y-90) embedded into nonbiodegradable glass microspheres. It is selectively administered by intraarterial hepatic injection giving high doses of radiation to the tumor and sparing the liver parenchyma. It has been shown to improve survival and used as a bridge to transplantation and to downstage tumors for resection. Therasphere seems to have favorable safety profile and has been used in patients with portal vein thrombosis with successful outcome.

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Ectopic sebaceous glands occur rarely in the esophagus. A 65-year-old man presented with a history of discomfort during swallowing since the last 4 months. On upper gastrointestinal endoscopy, multiple wart-like grayish-yellow projections were detected and two of them were biopsied. Microscopically, they proved to be sebaceous glands in the esophagus. Histogenesis of this rare lesion is discussed in this case report.

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Colonic complications of Behcet's disease due to intestinal involvement are rarely reported in the literature. Ulcers are the most frequently seen intestinal complications that cause bleeding and perforation predominantly in the ileocecal region. In this article, we report a patient with Behcet's disease who presented with multiple perforations along the entire colon. Postoperative histopathological examination revealed multiple ulcers containing lymphocytic infiltrations in the small peripheral and submucosal venules. Intimal thickening and fresh intraluminal fibrin thrombosis were also seen in these venules.

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Hemangiopericytoma is a rare neoplasm that can occur in any part of the human body, but it rarely develops in the greater omentum. We report a case of a patient who presented with a huge abdominal lump. At laparotomy, a huge vascular tumor, which was observed originating from the greater omentum, was resected. Histopathology investigation revealed this tumor as a benign hemangiopericytoma with a malignant potential.

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Background/Aims: Although laparoscopic cholecystectomy (LC) has become the procedure of choice for cholelithiasis in the general population, many consider cirrhosis as a relative or absolute contraindication for laparoscopic surgery. The aim of this study was to confirm the safety of LC in cirrhotic patients in our set-up. Materials and Methods: This is a retrospective case series including all the patients with cirrhosis who underwent LC for gallstones from January 2000 to December 2006 at our institution. Data were analyzed for Child class, indication for surgery, hospital stay, and procedure-related morbidity and mortality. Results are given as mean ± standard deviation. Results: Thirty patients, including 21 females (median age: 42 years) underwent LC during the study period. There was no operative mortality. Twenty-four patients belonged to Child class A and 6 belonged to Child class B. Mean operative time was 80 ± 26 min. There was no incidence of bile duct injury, but two patients (6.7%) required conversion to open procedure. Mean hospital stay was 3 ± 2.7 days. Postoperative morbidity was observed in seven patients, including postoperative deterioration of liver function in 2, worsening of ascites in 2 and pneumonia, and port-site infection in 1. Two patients had significant drop in hemoglobin requiring blood transfusion. Conclusions: Cirrhosis is not a contraindication for LC and it can be performed safely in compensated cirrhotic patients with acceptable morbidity and mortality.

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Background/Aim: To find a correlation between symptoms of gastroesophageal reflux disease (GERD) and body mass index (BMI). Materials and Methods: A total of 603 patients who presented at Ghurki Trust Teaching Hospital and Surgimed Hospital Lahore with symptoms of GERD, were included and interviewed according to a validated GERD questionnaire. It included questions regarding GERD symptoms and their severity/frequency. Symptoms were defined: "frequent" if occurred daily; "occasional," if weekly; and "severe," if they were sufficiently intense to change lifestyle. Height and weight were also recorded and their BMI calculated. We used logistic regression analysis was performed to assess the association between the presence of each specific GI symptom and BMI. The odds ratios (OR) for a given specific symptom and 95% confidence intervals (CI) were computed from the coefficients in logistic regression models. Results: The prevalence of obesity was 25.3%, while 38.1% were overweight. There was an increase in reporting of GI symptoms in obese individuals compared to those with normal BMI who were taken as reference group. Frequent nausea, vomiting, early satiety, epigastric pain, heart burn, regurgitation, postprandial fullness, and dysphagia were present in 10.4, 5.6, 8.9, 17.2, 10.2, 22.1, 23.5, and 21.7%, respectively, of obese subjects compared to 7.9, 1.2, 6.5, 3.5, 4.4, 11.4, 17.1, and 16.6% of normal BMI subjects. BMI showed a positive relationship with frequent vomiting ( P = 0.02), epigastric pain ( P = 0.03), regurgitation of food ( P = 0.02), heart burn ( P = 0.002), and postprandial fullness (0.01). Conclusion: The majority of GERD symptoms have a greater likelihood of occurring with increasing BMI.

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One-half of the world's population has Helicobacter pylori ( H. pylori ) infection while dyspeptic symptoms affect one-third of the adult population, at least in the Western world. Data from epidemiological studies are controversial in terms of the association of H. pylori with non-ulcer dyspepsia (NUD) symptoms. Despite the frequency of occurrence of this clinical condition, no effective therapy exists in treating this disorder. With the strategic aim of treating NUD, a vast amount of evidence has accumulated towards eradicating H. pylori , while an equally compelling amount of evidence exists that counters this very strategy. It is, therefore, vital that there is reliable evidence for the efficacy of treatments prescribed to NUD patients. The arguments for and against the eradication of this organism continues unabated. We aim to address both sides of this fundamental divide and present the differing perspective in light of the prevalent evidence.

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