[Fasciola hepatica--a unusual cause of acute cholecystitis with cholestatic jaundice]. / Fasciola hepatica--eine seltene Ursache der akuten Cholezystitis mit cholestatischem Ikterus.

A 29-year-old patient was admitted with acute abdomen in the 17th week of pregnancy. History revealed two episodes of colic in the right hypochondriac area during the previous six months, but no other abdominal complaints. Clinically the picture was that of acute cholecystitis. Laboratory findings included an elevated white cell count, a slight elevation of serum transaminases and a marked increase of serum alkaline phosphatase and bilirubin. Echographically there were dilated intra- and extrahepatic bile ducts containing two hyperechogenic elements without casting an acoustic shadow. A hydrops of the gallbladder with sludge and a thickening of the wall could also been seen. Because of pregnancy an ERCP could not be performed due to the need for X-ray, so we had to resort to open surgery. Under tocolytic and antibiotic shielding we carried out open cholecystectomy and choledochoscopic exploration of the common bile duct. Using a Fogarty balloon catheter we extracted two live, adult liver flukes and placed a T-tube in the duct. Because of positive fecal probes for fasciola eggs the T-tube had to be left in place until childbirth. Afterwards we performed a pre-cut-papillotomy by ERCP and took the T-tube out, having confirmed a clear duct on a T-tube-cholangiogram. With negative fecal probes and the eosinophilia on the white cell count returning to normal, we decided against the planned chemotherapy and assumed self-healing of the disease. The patient has been well since.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hepatic manifestations of the acquired immunodeficiency syndrome (AIDS)]. / Hepatische Manifestationen des erwobenen Immunmangelsyndroms (AIDS).

Hepatic manifestations of acquired immunodeficiency syndrome (AIDS) were analyzed in 76 consecutive patients. Serological markers of hepatitis B were found in 84%. All instances of biopsy-proven chronic hepatitis were associated with delta infection. One patient with intestinal cryptosporidiosis had a severe cholestasis. In the majority of patients histological examination of the liver revealed non-specific alterations, but in several cases was diagnostic of mycobacterial disease. The study of liver disease in HIV-infected patients could lead to a better understanding of diseases such as chronic hepatitis B and sclerosing cholangitis.