[Acute hepatitis as the leading symptom of secondary syphilis]. / Akute Hepatitis als Leitsymptom einer Sekundärlues.

HISTORY AND CLINICAL FINDINGS: A 44-year-old heterosexual man reported having been jaundiced for 4 days. He drank little alcohol. There was no history of venereal disease. INVESTIGATIONS: Laboratory tests indicated marked cholestasis (alkaline phosphatase 1589 U/I, gamma-GT 449 U/I), but only moderately raised transaminases (GOT 66 U/I, GPT 230 U/I), with a bilirubin level of 4.8 mg/dl. Ultrasonography revealed diffuse parenchymal damage in the liver, while endoscopic retrograde cholangiopancreatography showed no abnormalities. Viral hepatitis was excluded by serological tests. Histology of a liver biopsy showed inflammatory infiltration of the portal areas and of the liver parenchyma. Routine syphilis serology indicated fresh infection with Treponema pallidum. There was a healing painless ulcer in the area of the sulcus coronarius of the genitals. TREATMENT AND COURSE: 2.4 mill. I.U. benzathine benzylpenicillin were administered intramuscularly. This rapidly improved his condition and liver function tests became normal. CONCLUSION: In case of hepatitis of uncertain genesis syphilis should be considered as a possible cause, even in the absence of other signs of the disease.

The pancreas as a site of granulomatous inflammation in Crohn's disease.

Several reports on the occurrence of pancreatic dysfunction complicating Crohn's disease have been published during the past few years. Nevertheless, the pathogenesis of these disorders remains controversial. In this report, we describe a patient presenting with extrahepatic cholestasis and a mass in the head of the pancreas. Histological examination showed a granulomatous inflammation caused by Crohn's disease involving the stomach, the duodenum, and the head of the pancreas, clearly showing that the pancreas can also be a localization of Crohn's disease. Granulomatous inflammation could be an important factor in the pathogenesis of pancreatic dysfunction occurring in association with Crohn's disease.

[Blood-pool-SPECT for imaging portosystemic collaterals in portal hypertension]. / Blutpool-SPECT zur Darstellung von portosystemischen Kollateralen bei portaler Hypertension.

In 46 patients, 26 male and 20 female, age from 32 to 71 years (mean 47.4 +/- 11 years) a bloodpool-scintigraphy (BPS) with SPECT (single photon emission computed tomography) was performed. The in-vivo labelling of the erythrocytes with pyrophosphate and Tc-99m was performed in the usual way. The SPECT investigations were performed with a digital Anger-Camera (Elscint; Apex 401). In 14 patients without collaterals BPS was performed to compare the method with patients with liver diseases and collaterals. 29 patients with liver cirrhosis and portal hypertension were investigated with the BPS and additionally a scintisplenoportography (SSP) was performed. In patients with only cephalad collaterals all the results were concordant. In just 1 patient with cephalad and caudad collaterals we found a discordant result. In 8 patients we performed BPS, SSP and a katheterangiography (KA). Taking the KA as the "golden standard" we found a concordant result with the 3 methods in all patients with cephalad collaterals. In patients with cephalad and caudad collaterals we once found a discordant result with the SSP and twice with the BSP. In 2 patients the patency of surgical shunts were proved. 2 patients after sclerosis of the oesophageal varices have been proved by BPS and SSP and both patients showed good therapeutical results.

[Diagnosis of liver and biliary diseases with 99mTc-Hepatobida (author's transl)]. / Hepatobiliäre Diagnostik mit 99mTc-Hepatobida.

Application of 99mTc-Hepatobida has turned out to be a convenient diagnostic screening method in liver and biliary disease. Side effects are unknown, thus patients with iodine allergy or other forms of allergy, as well as patients harboring autonomous adenomata of the thyroid, and severely ill patients will tolerate this substance well. 99mTc-Hepatobida may be applied even in the presence of highly elevated levels of plasma bilirubin and thus will yield diagnostic results in all forms of hepatic disease if findings are monitored repeatedly. In addition screening with 99mTc-Hepatobida will in some cases suffice to establish the diagnosis and thus forgo more complicated diagnostic procedures.