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Background: Immunoglobulin G4-related disease (IgG4-RD) is a systemic disease which can potentially affect any organ system. IgG4-related sclerosing cholangitis and inflammatory pseudotumour in the hepatobiliary system is rare, but is probably underdiagnosed., Case Presentation: We present the case of a 52-year-old male who was admitted with obstructive jaundice and weight loss. He presented with a mass lesion in the porta hepatis mimicking hilar cholangiocarcinoma. The patient underwent extended right hepatectomy with hepaticojejunostomy. Severe liver failure developed postoperatively, and the patient underwent liver transplantation. The resected specimen showed infiltration of IgG4 positive plasma cells in the liver hilum, and immunohistochemical staining demonstrated a ratio of IgG4/IgG-positive plasma cells of more than 40 %. Postoperative serological testing showed elevated levels of serum IgG4 6.0 g/L (0.03-2.01), and the CT imaging revealed chronic pancreatitis and bilateral enlargement of the submandibular glands. The patient was ultimately diagnosed with IgG4-related disease., Interpretation: It is difficult to distinguish benign bile duct strictures in the porta hepatis from hilar cholangiocarcinoma, and serum IgG4 is unreliable as a diagnostic marker due to low sensitivity and specificity. Greater awareness of IgG4-RD is needed in order to avoid surgery.

BACKGROUND To estimate the prevalence, symptoms, causes and treatment of renovascular disease in children, and also to assess the degree of secondary organ damage to the heart, kidneys and eyes (end organ damage).MATERIAL AND METHOD Retrospective review of data for all children (0 - 16 years) who were examined for resistant hypertension in the period 1998 - 2013 at Oslo University Hospital Rikshospitalet.RESULTS A total of 21 children/adolescents (median age 8.5 years, 11 girls) were assessed and treated for resistant hypertension in the study period. Altogether had 38 % no symptoms at the time of diagnosis and 19 % had classical symptoms of hypertension. Fifteen patients received invasive treatment in the form of percutaneous transluminal renal angioplasty (PTRA) (n = 5), nephrectomy (n = 6), coiling (n = 1), autotransplantation (n = 1) or a combination of these (n = 2). Blood pressure improved following treatment in 10 of 14 patients for whom outcomes were recorded in the medical records. End organ damage to the heart and retina was observed in 60 % and 50 % of patients, respectively.INTERPRETATION Children with severely elevated blood pressure as a result of renovascular disease often have unspecific or no symptoms. Blood pressure improved following invasive treatment in 10 of 14 children and few complications were recorded. Invasive treatment may be considered in children and adolescents when standard treatment for hypertension is insufficient.

Background: Patients with chronic intestinal failure are treated primarily with parenteral nutrition, often for many years. If serious complications arise for intravenous nutritional therapy, it is possible to perform intestinal or multi-organ transplantation in selected patients. We have established a collaboration with Professor Michael Olausson at Sahlgrenska University Hospital in Gothenburg and Professor Andreas Tzakis at the Jackson Memorial Hospital in Miami, USA, to provide an option for Norwegian patients with chronic intestinal failure., Material and Method: Retrospective long-term study of seven patients (five in Gothenburg and two in Miami) with chronic intestinal failure who underwent intestinal or multi-organ transplantation (ventricle, duodenum, pancreas and small intestine) in the period 2001-2009. At the same time, liver and kidney transplantations were performed on six and two patients, respectively., Results: Four of seven patients are alive and have a good quality of life 24-120 months after the transplantation. The graft function is satisfactory, so that the patients' food intake is mainly oral. Three patients died following a serious infection one, ten and 24 months, respectively, after transplantation took place., Interpretation: Intestinal and multi-organ transplantation is a demanding and expensive treatment. Life-long multi-disciplinary follow-up of the patients is necessary after the transplantation in order to ensure early diagnosis of rejection and infections. Collaboration with international centres has given Norwegian patients with chronic intestinal failure an option of transplantation with satisfactory long-term results.

Background: In Norway, liver transplantation has been the treatment of choice for irreversible acute and chronic liver failure for 25 years. The aim of this article is to present a summary of the results obtained., Material and Methods: All liver transplants performed in Norway in the period 25.02.84-31.12.08 have been reviewed retrospectively with respect to patient and donor epidemiology, survival and recurrence., Results: 651 transplants have been performed in this period. The annual number of transplants increased gradually up to the year 2000 (31), and more steeply afterwards - to 79 in 2008. Also the number of organ donations has increased and reached 98 (20 pr. million inh.) in 2008. 5-year patient survival was 53 % in the period 1984-1994. In the period 2001-2008, 1-year survival was 90 % and 5-year survival was 83 %., Interpretation: The gradual improvement of results should be interpreted in light of improvements within transplant surgery, medicine and anaesthesiology and the increased local experience due to the increasing number of transplants performed. The transplant centre at Rikshospitalet has developed into being among the largest of its kind within the Nordic Countries and the results compare well with the best international data.

Background: Adrenocortical carcinoma is a highly malignant tumour with a poor prognosis. Surgery is the treatment of choice, with repeated procedures if necessary., Material and Methods: A 39-year-old woman presented with a pronounced Cushing's syndrome with virilizsation. Investigations showed an adrenocortical carcinoma with a diameter of 12 cm and two large metastases in the liver. She was admitted for palliative surgery. The primary tumour and one liver metastasis were resected. Three months later a right hepatectomy was performed, with excision of the remaining liver metastasis. Mitotane tablets were given all the time., Results: After the first operation the patient's clinical condition improved radically. Two years later she was clinically healthy without any tumours and normal hormone levels. After 27 months a relapse in the liver was found by computed tomography, and after 33 months steroid hormone precursors again increased. Radiotherapy to the liver metastasis was given, and at 48 months the patient is still healthy and has no relapse., Interpretation: Patients with adrenocortical carcinoma should be treated with extensive surgery, if necessary with repeated resections. Additional chemotherapy should be considered. This case confirms that surgical therapy has effect on metastasizing and hormone producing adrenal carcinoma and we consider that intensive surgery has improved this patient's prognosis.

Background: Though the great majority of hepatic and perihepatic neoplasms may very well be treated by conventional surgical techniques, a few patients will have lesions seemingly inaccessible by traditional in situ surgical procedures., Material and Method: We present two patients with retrohepatic sarcoma and liver haemangioma respectively, treated by hepatectomy, ex situ resection and hepatic autotransplantation., Results: The first patient, a 64-year-old man, had a completely uneventful postoperative course and had no indication of recurrent sarcoma two years later. The second patient, a 29-year-old female with a giant hepatic haemangioma developed postoperative hepatic artery thrombosis. Following thrombectomy her further course was satisfactory and the patient was discharged with normal liver function three weeks postoperatively., Interpretation: Ex situ liver surgery (bench surgery) with liver autotransplantation should be considered when traditional in situ surgery on the liver or adjacent structures is not applicable.

Local intra-arterial low-dose thrombolysis has become a therapeutic alternative for acute and subacute occlusion of vascular grafts and native vessels in the lower limbs. The series comprises 31 patients treated with Streptokinase as thrombolytic agent. Complete primary thrombolysis was achieved in 20 patients, whereas in 11 patients the outcome was only partially successful or a failure. Vascular stenoses were considered to precipitate thrombosis in 18 cases, and prompted percutaneous transluminal angioplasty after thrombolysis. Two-year patency was 48% (30-66%) in the total series and 74% (56-92%) among the patients with successful primary thrombolysis. There were no major complications. Five patients sustained local inguinal haemorrhage, of whom three required surgical revision. Local intra-arterial thrombolysis is an elaborate procedure associated with potential hazardous complications. It should be carried out in institutions with radiological and vascular surgical expertise.

Over a period of ten years, from 1980 to 1989, 701 hernioplasties were performed in 592 patients. 582 of these patients were available for follow-up examination (83%). The average follow-up was 10.3 years, median 10.2 years. The recurrence rate was 12%, 8% of the recurrences occurred after hernioplasties performed by specialists, and 13% after operations performed by surgeons in training. The results are discussed. The authors briefly review recent developments in hernia surgery.

During recent decades the number of operations for peptic ulcer has decreased significantly. The incidence of operations for peptic ulcer or related complications during the period 1975-89 in persons older than 15 years was investigated in the Nord-Trøndelag region of Norway, with a population of approximately 100,000. The number of elective surgical procedures decreased by 72% from 1975 to 1989. The greatest reduction was found for duodenal ulcers. The incidence of acute operations decreased by 35%. The main reason was fewer surgical interventions in patients with haemorrhage, since the number of operations for perforation remained almost constant during the period of 15 years. The reduction in surgical treatment can be explained mainly by the introduction of new H2-antagonists in the seventies, leading to more successful pharmacological treatment of peptic ulcer.