The relationship between juxtapapillary duodenal diverticula and biliary stone disease.

OBJECTIVE: To assess the relationship between juxtapapillary duodenal diverticula (JDD) and common bile duct stones and biliary stone disease in general. DESIGN: A retrospective study. METHODS: We analysed 1115 patients who underwent consecutive endoscopic retrograde cholangiopancreatography examinations. The patients were subdivided into three groups: the first group (group I; n = 482) had no biliary stone disease, the second one (group II; n = 329) had common bile duct stones, and the third group (group III; n = 304) had biliary stone disease of the gallbladder but without evidence of common bile duct stones. Additionally, the patients were subdivided into age groups of < 50, 50-59, 60-69, 70-79, and > or = 80 years of age. Logistic regression was applied for statistical analysis. RESULTS: Juxtapapillary duodenal diverticula were diagnosed in 111 (10.0%) patients. The incidence of JDD was 6.9% in group I, 14.3% in group II and 10.2% in group III. Age was the most dominant influence factor for JDD, common bile duct stones, and biliary stone disease (P < 0.0001). Sex was also a factor, female patients having a higher risk for common bile duct stones (P = 0.01) and biliary stone disease (P < 0.0001). After adjustment for age and sex, JDD was found to have a noticeable, but not statistically significant (P = 0.073), influence on common bile duct stones and no influence on biliary stone disease (P = 0.15). CONCLUSION: Our data support only moderately the existence of a relationship, which had been conjectured in a part of the literature, between JDD and common bile duct stones. No noticeable influence on biliary stone disease was found.

Primary leiomyosarcoma of the liver--a case report.

This is the 17th report on primary leiomyosarcoma of the liver in world literature. In 1980, a 69-year old white female patient was admitted with pain in the right upper abdomen and loss of weight of 12 kg. Increased blood sedimentation rate, elevated serum markers of the liver and ultrasound evolved a big tumor of the right liver without extrahepatic tumor nodules. Right hemihepatectomy was undertaken, the tumor was completely resected. After histologic examinations, leiomyosarcoma of the liver with 1 mitosis per 10 high power fields was diagnosed. 10 years later, the patient was readmitted with symptoms of pain, tiredness and night sweat. At this time, 3 intrahepatic and 1 retroperitoneal tumor nodules were detected. A sure-cut needle biopsy revealed the recurrent leiomyosarcoma with 4 mitoses per 10 high power fields. The survival period of 10+ years is the longest of all 17 patients with primary hepatic leiomyosarcoma reported so far. The low rate of mitoses per high power field and primary surgical resection are considered the reasons for the long survival period.

[Experiences with liver transplantation in hepatitis B antigen positive liver cirrhosis]. / Erfahrungen mit der Lebertransplantation bei Hepatitis-B-Antigen positiver Leberzirrhose.

From 1982 to January 1991 228 orthotopic liver transplantations (OLT) were performed in 213 patients with end-stage disease at the Vienna transplantation centre, 1st University Department of Surgery. 14 patients were serum HBV surface antigen (HBsAg) positive at the time of transplantation. In the first 4 patients only OLT was performed; postoperatively all grafts became reinfected and the patients developed chronic hepatitis. In a further series, immunoprophylaxis against hepatitis B virus reinfection was carried out with hyperimmuneglobulin. In 4 patients short-term immunoprophylaxis was performed; all of them were seronegative after OLT, but HBsAg ++reoccurred in the serum within 3-16 weeks after transplantation and all patients experienced reinfection of their graft. The 2 patients, who had been transplanted in a replicative state (HBeAg positive) showed a fatal course of hepatitis in the graft. Out of 6 patients given long-term immunoprophylaxis 3 cases showed stable liver function, without any signs of reinfection, and the HBsAg negative status remained for up to 19 months after transplantation. Since two patients displayed a HBV replicate status prior to transplantation, alpha interferon was administered preoperatively, which resulted in decreased serum HBV-DNA levels.

Diagnostic significance of endoscopic biopsy in Crohn's disease.

We investigated the diagnostic value of biopsies taken from Crohn's lesions such as ulcers, aphthoid lesions, cobble-stone epithelium and "pseudopolyps". One hundred and forty-six colonoscopies performed in 141 patients with Crohn's disease (CD) were analyzed. Biopsies were taken during colonoscopy from different gross lesions. Histologic confirmation of CD by granulomas and microgranulomas was obtained in 36 cases from 146 colonoscopies (24.7%). In 80 investigations (54.8%) the histologic findings were consistent with, but not diagnostic of, CD, in 30 cases (20.5%) histology was non-diagnostic. The lesions most likely to contain granulomas were ulcers and we therefore conclude that biopsies taken from ulcer are diagnostically superior to those taken from other lesions seen in CD.

Surface phenotypes of human peripheral blood mononuclear cells from patients with gastrointestinal carcinoma.

Peripheral blood mononuclear cells (PBMC) from 40 patients with gastrointestinal carcinoma (GIC), 13 patients with primary carcinoma in other localizations(non-GIC), and from 57 apparently healthy donors were isolated by Ficoll-Paque gradient centrifugation. The separated cells were stained with several monoclonal antibodies and subjected to analysis on a fluorescence-activated cell sorter. A decreased percentage of PBMC expressing T cell antigens was noted amongst GIC patients, and was mainly due to a reduction of the Leu 2a subset, thus, leading to an increase in the Leu 3a/Leu 2a ratio from 1.4 to 2.1 Non-GIC patients had decreased numbers of both T helper and suppressor cells. Amongst PBMC from GIC and non-GIC patients a statistically increased percentage of cells expressed LeuM 2 (P less than 0.001), LeuM 3 (P less than 0.001), OKM 1 (P less than 0.005), VEP 9 (P less than 0.001), and HLA-DR (P less than 0.001) antigens compared to healthy controls. The percentage of cells bearing these monocyte/macrophage antigens correlated well with the number of cells having monocyte morphology, stained for non-specific esterase, phagocytosed latex particles, and expressed Fc IgG receptor. Our results demonstrate clearly that tumor-bearing patients have an increased relative number of monocytes. The data suggest that cells of the macrophage lineage may be involved in defense mechanisms and changes of the immune system evoked by various tumors.