[Autoimmune hepatitis, autoimmune gastritis, hypergastrinemia and stomach carcinoid]

A 48-year-old woman with type II diabetes developed fatigue, arthralgia and myalgia. A few weeks later she was found to have hepatomegaly. The erythrocyte sedimentation rate was raised (53/93 mm), as were liver enzyme activities (GOT 186 U/l; GPT 240 U/l; gamma-GT 199 U/l), the gamma-globulin levels (40.7%;IgG 4470 mg/dl, IgA 698 mg/dl, IgM 245 mg/dl), antinuclear antibodies and antibodies against double-strand DNA, smooth muscles and actin. Laparoscopy revealed small-nodular liver cirrhosis. The autoimmune hepatitis was treated with prednisolone (initially 60 mg daily, then reduced to 10 mg daily) and azathioprine (initially 100 mg daily, reduced to 50 mg daily). The symptoms markedly improved. But one year later, during follow-up examination, gastric polyps were found, excised and histologically found to be carcinoid. The gastrin level was raised to 765 pg/ml. Another year later the liver cirrhosis had advanced further and the type A gastritis was still present, but there was no sign of carcinoid recurrence.

[Fibrolamellar hepatocellular cancer]

Clinical and histopathologic features of the fibrolamellar variant of hepatocellular carcinoma allow a differentiation from the usual hepatocellular carcinoma. It's most common in younger adults and occurs equally in either sex. Liver cirrhosis is absent in most cases. The prognosis ist favorable. Surgical resection might lead to a definitive cure. This tumor is an import differential diagnosis of space occupying lesions in younger adults.

[Arterial embolization of an arteriovenous fistula with hemobilia after blind liver puncture]

Five days after percutaneous liver biopsy we observed in a 42-year-old man with alcoholic liver cirrhosis severe hemobilia requiring transfusions of packed red cells. By means of super-selective arterial embolization, using gelfoam, the bleeding source, an av-fistula, was successfully occluded. Iatrogenic hemobilia, although seen after percutaneous liver biopsy only in app. 0.005% of the cases, is today the most important cause of biliary bleeding, mainly as a complication (app. 3% of the cases) of the widespread use of interventional procedures of the biliary tree (e.g. PTCD). Therapeutically arterial embolization should be considered first if possible.

[T-cell lymphoma associated with sprue]

A 47-year-old woman, known to have coeliac disease, developed bouts of fever, up to 39 degrees C, with loss of weight and treatment-resistant diarrhoea, as well as swelling of the submandibular, axillary and inguinal lymph nodes. Tests revealed a pancytopenia (haemoglobin 8.8 g/dl, leucocytes 500/microliter, platelets 19,000/microliter), and a reduction of the Quick value to 39%. Computer tomography demonstrated extensive abdominal lymphomas. The patient's general condition quickly deteriorated, hypoproteinaemia developed (total protein 4.6 g/dl) with peripheral oedema, ascites and pleural effusion. She died before the suspected diagnosis of coeliac disease-associated malignant lymphoma could be confirmed. Autopsy demonstrated a highly malignant, pleomorphic, primary abdominal non-Hodgkin lymphoma, immunohistologically a T-cell lymphoma.

A thread as a nidus of a common bile duct calculus--findings during endoscopic lithotripsy

Suture material can serve as a nidus for common bile duct calculi. We saw an unusually long thread projecting from a mixed common duct stone in a woman 30 years after cholecystectomy. The calculus was removed endoscopically after mechanical lithotripsy. The implications of this observation, in particular as a potential complication, are discussed.

[Spontaneous splenic rupture in infectious mononucleosis--organ-sparing operation using fibrin glue]

We present the case of a 16-year-old female patient with infectious mononucleosis complicated by spontaneous splenic rupture on the eighth day of the disease. This event is seldom; only 38 cases of true spontaneous rupture of the spleen in infectious mononucleosis could be found when the literature was reviewed. The diagnosis of splenic rupture in our case was made by ultrasound, just as the further postoperative follow-up. For the first time the splenic lesion was successfully managed by application of fibrin tissue adhesive.

[Association of primary biliary liver cirrhosis with sarcoidosis--separate diseases or a new nosological entity?]

Primary biliary cirrhosis of the liver and sarcoidosis have certain clinical and histomorphological features in common. It has been inferred from this that when the two diseases occur together its assignment to the one or other is not possible and a new nosological entity is to be assumed. Two own cases are described. Both had primary biliary cirrhosis, sarcoidosis developing 12 and 13 years, respectively, after the former had been first diagnosed. The findings in this cases speak against the two diseases constituting a nosological entity.

[Congenital cystic dilatation of the intrahepatic bile ducts (Caroli syndrome)]

Caroli's syndrome is a rare disease, six cases of which were under the authors' care between 1979 and 1986. None had associated congenital hepatic fibrosis; one had an associated choledochal anomaly. Endoscopic retrograde cholangiography proved to be the most sensitive diagnostic method. Liver abscess and secondary biliary cirrhosis of the liver developed as complications. Partial liver resection was possible in two patients in whom only one lobe had been affected.