Haruya Meren

Effect of acute and chronic ethanol consumption on hepatic tissue oxygen tension in rats

In vivo hepatic tissue oxygenation was investigated in chronically ethanol-treated rats using micro oxygen electrode and reflectance spectrophotometry. Effect of acute ethanol administration was also studied. Hepatic oxygen tension of rats treated with ethanol chronically (daily ethanol intake, 9-12 g/kg for 9 months) was very low as compared with that of normal rats, the decrease being comparable to that of rats treated with carbon tetrachloride. The hepatic oxygen tension in normal controls shortly after ethanol ingestion increased from basal level (median, 23 mmHg) to 40-70 mmHg, while in chronically ethanol-treated rats, the hepatic oxygen tension decreased transiently, followed by a gradual increase, but it still remained low. In CCl4-treated rats, the hepatic oxygen tension decreased further after the ethanol ingestion. It is concluded that chronic ethanol consumption in rats resulted in hepatic hypoxia with decreased liver blood flow and volume. Also acute ethanol administration does not induce hepatic hypoxia in normal rats, while in rats with injured liver it induces hypoxia.

A CASE OF DIFFUSE‐TYPE EARLY GASTRIC CANCER WITH NODULAR GASTRITIS

A 39‐year‐old woman was referred to Osaka Police Hospital and admitted for surgical treatment of gastric cancer. Barium upper gastrointestinal study and endoscopic examination showed a 3.0 × 3.0 cm depressed lesion in the greater curvature of the middle corpus. An unusual miliary pattern resembling ‘goose flesh’ was observed endoscopically in the antrum. Biopsy specimens from the tumor showed poorly differentiated adenocarcinoma, and specimens from the antrum showed many lymphoid follicles with a germinal center. Rapid urease test and histological tests (Giemsa stain) for Helicobacter pylori were both positive. Early gastric cancer with nodular gastritis (NG) was diagnosed and a partial gastrectomy was performed. Histological examination of the resected specimen showed a stage I tumor consisting mainly of signet‐ring cell carcinoma restricted to the mucosa. Postoperatively H. pylori eradication therapy was performed and proved to be successful. One year after eradication therapy, endoscopy with biopsy showed no recurrence of gastric cancer and the remarkable regression of antral NG.

Massive gastrointestinal bleeding in a patient with polyarteritis nodosa

To the Editor: There have been a few reports about muscle toxicity induced by omeprazole. We would like to report a case of rhabdomyolysis associated with the intravenous administration of omeprazole. A 56-year-old Japanese man visited Tokyo Metropolitan Police Hospital with an episode of nausea and dizziness that had begun the previous evening. He had been diagnosed as suffering from arrhythmia at the age of 51, and was a heavy drinker. Physical examination was unremarkable. Clinical investigations revealed anemia (hemoglobin [Hb], 10.8g/dl); leukocytosis (WBC, 11 900/ μl); and hyperlipidemia, (triglyceride [TG], 169mg/dl). Renal and liver functions were within normal limits. After being admitted, he presented with massive hematemesis due to Mallory-Weiss syndrome. Esophageal and gastric hemorrhage was treated with endoscopic clipping and intravenous omeprazole, 20mg twice a day. The patient generally improved, but his serum creatine phosphokinase level gradually became elevated. On his fifth day in hospital, it rose to 3856IU/l (normal range, 43–272IU/l), while his serum myoglobin level was 467ng/ml (normal range, 65ng/ml). Physical and neurological examination results were unremarkable. Creatine kinase isoenzyme showed a 0.5% MB fraction, and serum myosin light chain I and cardiac troponin T levels were within normal limits. Electrocardiogram results and thyroid function were normal. After withdrawal of omeprazole, the laboratory data improved within 5 days. The patient was discharged on the fifteenth hospital day, and a follow-up examination showed that he was doing well 6 months later. Although our patient’s physical findings were negative for rhabdomyolysis, these laboratory findings usually indicate rhabdomyolysis due to destruction of skeletal muscle.1 There are a few scattered reports of muscle toxicity with marked elevation of serum creatine phosphokinase2,3 induced by omeprazole taken orally. The exact mechanism is not known, but we should be aware of possible side effects associated with the intravenous administration of omeprazole.

SUCCESSFUL ENDOSCOPIC HEMOSTASIS OF RECTAL DIEULAFOY's ULCER BY CLIPPING: AGING MAY BE A FACTOR

Dieulafoys ulcer is a rare form of gastrointestinal bleeding. Although the original descriptions and early reports were of lesions in the proximal stomach, similar lesions have subsequently been reported in the esophagus, duodenum, jejunum, colon and rectum. A 55‐year‐old man was admitted to hospital for a sudden acute headache. On admission he was conscious, and had severe occipitalgia due to a subarachnoid hemorrhage demonstrated on computed tomography. On the fifteenth hospitalization day, he passed fresh blood together with stool, followed by several further episodes of massive hematochezia. Although no lesion was found by gastroduodenoscopy, colonoscopy revealed fresh blood and clots in the rectum. No obvious source of hemorrhage could be identified until careful irrigation revealed pulsatile bleeding from a protuberant vessel (2 mm in size) in the rectum 5 cm from the anal verge. The patient underwent an endoscopic hemostasis in which the pulsatile vessel was easily sutured with seven clips. The patient did not have another episode of bleeding. The finding of Dieulafoys ulcer in the elderly‐patient group suggests that sclerotic changes to the artery may be associated with this type of rectal ulcer.

Characterization of Hepatic Hemodynamics in Cirrhotics and Non-Cirrhotics Effect of Glucagon Infusion

The effect of glucagon on hepatic regional hemodynamics was investigated in patients with chronic liver disease during peritoneoscopy with reflectance spectrophotometry. When glucagon was infused intravenously in patients with a non-cirrhotic liver, the regional hepatic tissue oxygen consumption, as estimated spectrophotometrically, increased significantly, whereas the index of hepatic tissue blood volume did not change appreciably, and consequently, the oxygen saturation of hemoglobin in the hepatic tissue blood decreased. In contrast, the administration of glucagon in patients with liver cirrhosis resulted in a significant increase in the index of hepatic tissue blood volume and produced a minor increase in hepatic tissue oxygen consumption. The oxygen saturation of hepatic blood hemoglobin tended to increase in the cirrhotics. The result suggests the presence of functional vasoconstriction at the presinusoidal and/or sinusoidal vessels in the cirrhotic liver, possibly due to a decreased vasomotor activity and/or an abnormal regulatory function of vasoactive substances, which are released by glucagon.

Delivery and Use of Oxygen in the Hepatic Tissue Assessed by Organ-Reflectance Spectrophotometry

Although the importance of oxygen in maintaining functional and morphological integrity of the liver is well established in the experimental animal, little is known about the oxygen supply and utilization in the liver in patients with chronic liver diseases. We have recently developed a spectrophotometric method to estimate the concentration of hemoglobin in the hepatic tissue, the oxygen saturation of hemoglobin in the regional blood, and the hepatic oxygen consumption. In this study, to clarify whether the balance between delivery and use of oxygen in the hepatic tissue is disturbed in chronic liver disease, we investigated hepatic hemodynamics in patients with chronic liver diseases using reflectance spectrophotometry.