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Intrahepatic cholestasis without jaundice

Hepatobiliary & Pancreatic Diseases International 2009年第1期8卷 103-105页

作者： Thomas Namdar Andreas Raffel Stefan Andreas Topp Jan Schulte am Esch Günther Fürst Wolfram Trudo Knoefel claus ferdinand eisenberger Department of General Visceral and Pediatric Surgery Heinrich-Heine University Institute of Diagnostic Radiology Heinrich-Heine University

BACKGROUND:Cholangiocarcinoma(CC),the most common biliary tract malignancy,is frequently seen in advanced unresectable stages and is typically localized *** diagnosis is unusual because of nonspecific *** jaundice is usually the first sign of tumor. METHOD:We present a patient with a CC(Klatskin tumor) with a complete biliary drainage by an aberrant bile duct without jaundice. RESULTS:A 67-year-old woman presented with persisting elevation of liver *** tests showed a Klatskin tumor typeⅡ.A curative right hepatic trisegmentectomy was performed after liver volume augmentation by preoperative vein embolization. CONCLUSIONS:A direct drainage of the right posterior bile duct into the common bile duct as an aberrant hepatic duct is a rare variation and is present in less than 5%of the *** case of persistently perturbed liver function tests,an aberrant bile duct can cover up severe intrahepatic cholestasis and even obscure the diagnosis of a Klatskin *** to now it has not been described in the literature.

关键词： Klatskin tumor hyperbilirubinemia cholangiocarcinoma

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Complications and treatment of migrated biliary endoprostheses:A review of the literature

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World Journal of Gastroenterology 2007年第40期13卷 5397-5399页

作者： Thomas Namdar Andreas Martin Raffel Stefan Andreas Topp Lisa Namdar Ingo Alldinger Marcus Schmitt Wolfram Trudo Knoefel claus ferdinand eisenberger Department of General Visceral Pediatric SurgeryHeinrich-Heine UniversityDüsseldorf 40225Germany Department of Gastroenterology Hepatology InfectiologyHeinrich-Heine UniversityDüsseldorf 40225Germany

Endoscopic biliary stent insertion is a well-established procedure. It is especially successful in treating postoperative biliary leaks, and may prevent surgical intervention. A routine change of endoprostheses after 3 mo is a common practice but this can be prolonged to 6 too. We reported a colonic perforation due to biliary stent dislocation and migration to the rectosigmoid colon, and reviewed the literature.

关键词： Biliary endoprostheses Migrated biliarystent, Colonic perforation, Biliary stent complications

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Extrahepatic intraductal ectopic hepatocellular carcinoma:bile duct filling defect

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Hepatobiliary & Pancreatic Diseases International 2009年第6期8卷 650-652页

作者： Moritz Schmelzle Hanno Matthaei Nadja Lehwald Andreas Raffel Roy Y.Tustas Natalia Pomjanski Petra Reinecke Marcus Schmitt Jan Schulte am Esch Wolfram T.Knoefel claus F.eisenberger Department of General Visceral and Pediatric Surgery Heinrich-Heine-University Düsseldorf Institute of Cytopathology Heinrich-Heine-University Düsseldorf Institute of Pathology Heinrich-Heine-University Düsseldorf Department of Gastroenterology Hepatology and Infectious Diseases Heinrich-Heine-University Düsseldorf

BACKGROUND:Obstructive jaundice caused by an intraductal hepatocellular carcinoma is a rare initial *** report a rare case of an extrahepatic icteric type hepatocellular ***:A 75-year-old patient was admitted to our hospital because of obstructive jaundice 3 months after resection of multilocular hepatocellular carcinoma.A postoperative bile leakage was treated by placement of a decompressing stent in the common bile *** retrograde choledochoscopy showed extended blood clots filling the bile duct system and computed tomography revealed a local swelling in the common extrahepatic bile *** level of alpha-fetoprotein(AFP)was only slightly elevated but that of CA19-9 was dramatically *** showed an intraductal filling defect typical of a cholangiocellular ***:Bile duct brushing cytology showed no cholangiocellular carcinoma but hepatocellular carcinoma cells in the extrahepatic bile *** extrahepatic bile duct resection was *** examination confirmed the diagnosis of extrahepatic intraductal growth of hepatocellular ***:Ectopic hepatocellular carcinoma is a rare but important differentially diagnosed of extrahepatic bile duct filling defect.

关键词： hepatocellular carcinoma cholangiocellular carcinoma bile duct obstructive jaundice

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体外冲击波震石在泌尿外科的新进展

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德国医学 1998年第4期15卷 238-240页

作者： DIRK M.WILBERT DIETER JOCHAM ferdinand eisenberger CHRISTIAN CHAUSSY 胡志全章咏裳 ABTEILUNG UROLOGIE UNIVERSITTSKLINIKUM DER EBERHARD-KARLS-UNIVERSITYHOPPE-SEYLERSTR 同济医科大学附属同济医院

机器发展今天德国医疗市场上有5种类型的碎石机。尽管冲击波产生和聚焦方式各有不同,但所有机器均采用超声和 X 线结石定位是一致的。所有机器将 X线作为辅助性措施来应用,使胆囊结石、胆管结石、胰腺结石和涎石等非泌尿系治疗也可进行。

关键词：体外冲击波碎石 ESWL 肾盂结石输尿管结石

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Sporadic versus hereditary gastrinomas of the duodenum and pancreas: Distinct clinico-pathological and epidemiological features

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World Journal of Gastroenterology 2006年第34期12卷 5440-5446页

作者： Martin Anlauf Nele Garbrecht Tobias Henopp Anja Schmitt Regina Schlenger Andreas Raffel Markus Krausch Oliver Gimm claus F eisenberger Wolfram T Knoefel Henning Dralle Paul Komminoth Philipp U Heitz Aurel Perren Günter Klppel Department of Pathology Universityof Kiel Germany Department of Pathology University of Zürich Switzerland Department of Pathology Universityof Kiel Germany Department of Forensic Medicine Universityof Kiel Germany Department of General Visceral andPediatric Surgery University of Düsseldorf Germany Department of General andVisceral Surgery University of Halle-Wittenberg Germany

Gastrinomas are defined as gastrin secreting tumors that are associated with Zollinger-Ellison syndrome （ZES）. ZES is characterized by elevated fasting gastrin serum levels, positive secretin stimulation test and clinical symptoms such as recurrent peptic ulcer disease, gastroesophageal reflux disease and occasional diarrhea. Genetically, nonhereditary （sporadic） gastrinomas are distinguished from hereditary gastrinomas, which are associated with multiple endocrine neoplasia type 1 （MEN1） syndrome. In general, duodenal gastrinomas are small and solitary if they are sporadic and multiple as well as hereditary. The sporadic gastrinomas occur in the duodenum or in the pancreas while the hereditary gastrinomas almost all occur in the duodenum. Our series of 77 sporadic duodenal neuroendocrine tumors （NETs） includes 18 patients （23.4%） with gastrinomas and ZES. Of 535 sporadic NETs in the pancreas collected from the NET archives of the departments of pathology in Zürich, Switzerland, and Kiel, Germany, 24 patients （4.5%） suffered from sporadic pancreatic gastrinomas and ZES. These NETs have to be distinguished from tumors with immunohistochemical positivity for gastrin but without evidence of ZES. An additional 19 patients suffered from MEN1 and ZES. These patients showed exclusively duodenal gastrinomas, but not pancreatic gastrinomas. The prognosis of sporadic and MEN1- associated duodenal gastrinomas is better than that of pancreatic gastrinomas, since they progress slowly to liver metastasis. In summary, sporadic and MEN1- associated gastrinomas in the duodenum and pancreas show different clinico-pathological and genetic features. The incidence of sporadic duodenal gastrin-producing tumors is increasing, possibly due to optimized diagnostic procedures. In contrast, pancreatic MEN1- associated gastrinomas seem to be extremely rare. A considerable subset of tumors with immunohistochemical expression of gastrin but without evidence of ZES should be designated as functio

关键词： Endocrine tumor Gastrinoma Multiple endocrine neoplasia type 1 Precursor lesion Zollinger-Ellison syndrome

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