[Histopathology of Helicobacter pylori infections]. / Die Histopathologie der Helicobacter pylori-Infektion.

Helicobacter pylori (H.p.) infection is associated in essentially all patients with a chronic active gastritis. According to the Houston-update of the Sydney classification grade and activity of the gastritis, the occurrence of intestinal metaplasia and atrophy as well as the density of H.p. colonization have to be semiquantitatively determined by the pathologists. Gastric acid production influences the severity of gastritis in antrum and body mucosa. In a subgroup of patients other forms of gastritis, such as lymphocytic gastritis, giant fold gastritis and atrophic gastritis may develop. After eradication plasma cells may persist in the lamina propria for years.

[Cholestatic hepatitis as a rare side effect of therapy with ticlopidine]. / Cholestatische Hepatitis als seltene Nebenwirkung einer Therapie mit Ticlopidin.

A 71-year-old man with chronic atrial fibrillation was treated with aspirin because of a right cerebral infarction. Oral anticoagulation was not initiated because of a secondary hemorrhagic transformation. Six years later after a left cerebral transient ischemic attack aspirin was replaced by ticlopidine. Two weeks after starting ticlopidine he experienced abdominal cramps and diarrhea. Also dark urine and gray-colored stools were noticed, so that the patient stopped taking ticlopidine. 40 days after starting ticlopidine he was admitted to our hospital because of cholestatic jaundice. Serum alkaline phosphatase (305 U/l) and gamma GT (143 U/l) were elevated, the total bilirubin was 18.6 mg/dl at peak. GOT and GPT were 2.7 fold increased. After exclusion of a viral infection and autoimmune disease liver biopsy was performed, which showed a centroacinar cholestasis compatible with a drug-induced liver damage. 79 days after discontinuation of the drug laboratory signs of cholestasis had disappeared. In patients in whom long-term therapy with ticlopidine is indicated regularly laboratory tests and clinical examinations should be done to recognize infrequent side effects such as the cholestatic hepatitis in time.

Idiopathic enterocolic lymphocytic phlebitis: a rare cause of ischemic colitis.

We report on a 74-year-old female patient who was admitted to the hospital because of abdominal pain. She underwent a colonoscopy and a stenosing mass was found in the cecum. Histologic findings in the biopsy specimens were consistent with ischemic colitis. Due to clinical symptoms and the endoscopic and radiologic findings that roused the suspicion that the patient was suffering from a malignant tumor, a right hemicolectomy was performed. Histology of the resection specimen disclosed an inflammation of the veins. It was characterized by a predominantly lymphocytic infiltration of the vessels affecting the veins of the colonic wall and the mesentery. Furthermore, secondary thrombosis with focal venous occlusion was observed. The colon showed extensive ischemic colitis with focal transmural coagulation necrosis. The disease was considered to be idiopathic lymphocytic phlebitis, which is a rare disease of unknown origin. Our patient is well and alive after more than 1 year, supporting the notion that the disease shows a benign course after surgery.

[Aneurysm of the cystic artery as a rare cause of hemobilia]. / Aneurysma der Arteria cystica als seltene Ursache einer Hämobilie.

A 52-year old woman was admitted to the hospital because of upper abdominal pain and hematemesis. Laboratory parameters showed marked cholestasis. Endoscopic retrograde cholangiopancreatography (ERCP) lead to the diagnosis of hemobilia. CT-scan and angiography revealed an aneurysm of the cystic artery as the cause of hemobilia. Cholecystectomy was performed because of concomitant cholecystitis. Anatomical examination confirmed clinical diagnosis.

[Angiographic image of intestinal angiodysplasia of the duodenum in comparison with endoscopy--case report]. / Angiographisches Bild einer intestinalen Angiodysplasie des Duodenums im Vergleich mit der Endoskopie--Fallbericht.

Angiodysplasia of the bowel wall is a malformation of intestinal giodysplasia of the bowel wall is a malformation of intestinal blood vessels. There seem to be different aetiologies of this disease entity. It is reported to be a common cause of occult intestinal bleeding in patients with negative findings on primary endoscopy of the upper and lower gastrointestinal tract. They occur most frequently in the right colon. The case reported demonstrates endoscopy and arteriography of extensive angiodysplasia in duodenum and proximal jejunum causing severe bleeding.

A lethal course of chronic hepatitis C, glomerulonephritis, and pulmonary vasculitis unresponsive to interferon treatment.

Several extrahepatic syndromes have been associated with chronic hepatitis C virus infection. In our patient (a 57-yr-old woman without risk factors for hepatitis), chronic active hepatitis C was diagnosed serologically and histologically. Three months later, membranoproliferative glomerulonephritis with compromised renal function and peripheral edema, cryoglobulinemia, and a vasculitis of the finger tips developed. During interferon treatment for 3 months, neither the clinical condition nor serological parameters improved significantly. Progressive dyspnea was due to bilobar pulmonary infiltration. Despite antibiotic, virostatic, and corticosteroid therapy, the patient died from respiratory failure. Autopsy revealed diffuse pulmonary vasculitis. Thus, this is the first description of chronic hepatitis C virus infection, glomerulonephritis, and cryoglobulinemia complicated by immunologically mediated pulmonary vasculitis. Because interferon therapy may be ineffective, immunosuppressive therapy should be considered.

[Atypical clinical course of thoracic aortic dissection with subacute pericardial hemorrhage]. / Atypischer klinischer Verlauf einer thorakalen Aortendissektion mit subakuter Perikardblutung.

A case of dissecting aortic aneurysm is reported which occurred without significant pain but was complicated by a subacute pericardial bleeding leading to a large pericardial effusion. The patient was hospitalized because of clinical signs of cardiac tamponade which could be alleviated by pericardiocentesis. Neither 2D-echocardiography nor a portable x-ray of the chest disclosed evidence of aortic dissection. After a symptom-free interval of several hours the patient died because of recurring intractable pericardial tamponade. The differential diagnosis of a large hemorrhagic pericardial effusion should include rupture of a dissecting aortic aneurysm even when typical symptoms are lacking.

Surgical correction of cartilaginous nasal septum deformities.

Septal cartilage deviations which are usually present in deformities of the cartilaginous nasal septum are corrected by scarification on the concave side of the curvature. Histological studies indicated that this procedure was best adapted to the structure of the elastic fibres constituting the cartilaginous nasal septum. Follow-up examinations in 33 patients who having undergone surgery showed nasal breathing to be unobstructed bilaterally in all cases; in 29 patients an aesthetically satisfactory nasal shape was restored and full re-alignment of the cartilaginous nasal septum was obtained.