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The concentration of immunoglobulins and immune complexes was determined in the serum and bile of four patients with primary sclerosing cholangitis, only one of whom had chronic ulcerative colitis, and in four postcholecystectomy control patients. The result of the immunoglobulin studies demonstrated increased serum levels of IgM in primary sclerosing cholangitis as compared to control patients. The IgG, IgA, and IgM in bile were all significantly elevated as compared to controls (p = 0.02). Immune complexes in bile and serum were also determined in both groups by the Clq and conglutinin binding assays. Immune complexes in bile were elevated in three of four of the patients with primary sclerosing cholangitis. These findings further characterize primary sclerosing cholangitis in terms of biliary immunoglobulins and immune complexes but do not resolve whether these changes are an epiphenomenon or reflect a primary role of immunoglobulins and immune complexes in the pathogenesis of this disorder. [ABSTRACT FROM AUTHOR]

A 40-year-old man with a history of insulin-dependent diabetes mellitus was admitted to the hospital because of jaundice and pruritis. During his evaluation the diagnosis of primary sclerosing cholangitis and "microscopic" ulcerative colitis were established. Massive intraabdominal lymphadenopathy was discovered on CT scan and histological examination eventually proved this to be follicular hyperplasia. The case herein reported documents the association of primary sclerosing cholangitis with diabetes mellitus and ulcerative colitis as well as reporting the occurrence of massive intraabdominal lymphadenopathy. [ABSTRACT FROM AUTHOR]

A 66-year-old man with a past history of hyperparathyroidism was evaluated for chronic epigastric pain. An upper gastrointestinal x-ray examination revealed the presence of polypoid filling defects and endoscopy-polypectomy eventually proved these to be gastric carcinoids. [ABSTRACT FROM AUTHOR]

Ascites is uncommon in patients with hypothyroidism. Herein we describe an 84-year-old female patient with myxedema ascites that resolved completely with thyroid replacement medication. Bacteriological studies of the ascitic fluid revealed gram-negative rods which eventually proved to be Klebsiella pneumoniae treated successfully with antibiotics. Our review of the literature failed to reveal a previous case of myxedema ascites with concomitant subclinical spontaneous bacterial peritonitis. Copyright © 2003 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We report the case of a 26-yr-old patient with fulminant liver failure and acute hemorrhagic pancreatitis secondary to the use of trimethoprim-sulfamethoxazole (Bactrim DS). Our patient presented with skin rash and decreased C3 and C4 levels, which we believed was due to a hypersensitivity reaction secondary to the sulfonamide component (sulfamethoxazole). To our knowledge, this is the first case reported in which suffamethoxazole-trimethoprim has been implicated as a cause of fulminant liver failure and acute hemorrhagic pancreatitis simultaneously, and emphasizes the need of discontinuing this medication as soon as there is evidence of liver and pancreatic dysfunction. [ABSTRACT FROM AUTHOR]

A 65-yr-old man who developed sudden respiratory arrest was found to have a long, smooth, esophageal filling defect on esophagogram. Endoscopy eventually proved this to he a large esophageal polypoid lesion that had arisen in the hypopharynx and extended to the midesophagus. He was successfully treated with a lateral pharyngotomy and excision of the hypopharyngeal polyp. [ABSTRACT FROM AUTHOR]

An elderly woman with a history of cholelithiasis was seen for right upper quadrant pain and jaundice. During her evaluation, she was found to have extensive choledocholithiasis and a cholecystoduodenal fistula. Successful management was accomplished with cholecystectomy, removal of the common bile duet stones, and by creating a choledochoduodenostomy where the fistula had been present. [ABSTRACT FROM AUTHOR]

A 46-year-old woman was seen for evaluation of dyspepsia of 8-wk duration. X-rays of the upper gastrointestinal tract revealed an intraluminally projecting diverticulum of the duodenal bulb. Diagnostic features and management of intraluminal duodenal diverticulum are reviewed. [ABSTRACT FROM AUTHOR]

A 42-year-oId woman with a longstanding history of systemic lupus erythematosus and insulin-dependent diabetes mellitus was admitted to the hospital because of icterus, anorexia, pruritis, and weight loss of 3 months duration. During her evaluation the diagnosis of primary sclerosing cholangitis was established. The following case documents the unusual association of sytemic lupus erythematosus and insulin-dependent mellitus with primary sclerosing cholangitis. [ABSTRACT FROM AUTHOR]

Presents a case report of a female patient diagnosed with invaginating ampulla mimicking choledocholithiasis. Medical history of the patient; Findings of her endoscopic examination of the bile duct performed through a cholodochoduodenostomy; Discussion on the direct peroral endoscopic approach for diagnosis and treatment of the biliary tract disease.

A 56-year-old woman was admitted to the hospital because of icterus and pruritis of 1 month duration. During her evaluation, endoscopic retrograde cholangiography revealed large cystic duct stones causing partial obstruction of the common hepatic duct. Successful management was accomplished with choledochojejunostomy and T-tube decompression. The case herein reported illustrates the typical clinical presentation and radiographic features of the Mirizzi syndrome. [ABSTRACT FROM AUTHOR]

An adolescent with stunted growth was treated for 6 months with a synthetic anabolic androgen. During his evaluation for right upper quadrant pain an abnormal liver scan demonstrated what proved to be a hypervascular hepatic lesion. At surgery, the diagnosis of focal nodular hyperplasia was established. Herein we document the unusual association of focal nodular hyperplasia with use of a synthetic anabolic androgen. [ABSTRACT FROM AUTHOR]