Hidenori Katoh

Coagulopathy in Disseminated Intravascular Coagulation due to Abdominal Sepsis: Determination of Prothrombin Fragment 1+2 and Other Markers

To estimate the degree of coagulopathy in abdominal sepsis, we measured the plasma levels of prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin III complex (TAT) and plasmin-alpha 2-plasmin inhibitor complex (PIC) by the enzyme-linked immunosorbent assay in 38 patients with disseminated intravascular coagulation (DIC). In 20 patients with DIC due to abdominal sepsis, plasma levels of F1 + 2, TAT and PIC were 2.6 nmol/l, 27.9 micrograms/l and 1.5 micrograms/ml, respectively, with a mean antithrombin III (AT III) activity of 41.7%. F1 + 2, TAT, PIC and AT III levels were 4.7 nmol/l, 75.8 micrograms/l, 8.8 micrograms/ml and 70.9% in 18 patients with DIC as the result of malignancy. Though AT III levels in DIC due to sepsis were lower than those in DIC due to malignancy, the levels of F1 + 2, TAT and PIC in the former were not significantly more increased than those in the latter. The plasma levels of F1 + 2 were positively correlated with TAT and PIC in DIC patients with malignancy; however, there was no correlation between F1 + 2 and TAT or PIC in DIC patients with sepsis. In addition, the levels of serum albumin in the two groups were similar. These results suggest that activation of coagulation and fibrinolytic systems may not be so prominent in cases of DIC due to abdominal sepsis, compared to related events in DIC due to malignancy. It is also suggested that the depletion of AT III in cases of sepsis is not only caused by a consumption related to intravascular coagulation or to an alternate distribution of protein.(ABSTRACT TRUNCATED AT 250 WORDS)

Complete mole coexistent with a twin fetus

We report two cases of a complete hydatidiform mole coexistent with a live fetus diagnosed by DNA polymorphism analysis. A 27‐year‐old woman revealed symptoms of pre‐eclampsia and ultrasound showed multicystic tumor and placenta coexistent with a live fetus at 16 weeks’ gestation. The placenta with partly hydropic change and the fetus without anomaly were consequently evacuated. Another 30‐year‐old woman had a multicystic mass attached to a normal placenta with a 20‐week live fetus on ultrasound examination. A hysterotomy was carried out because of persistent bleeding due to placenta previa. In both cases, DNA was extracted from the placental tissue and the tumor, as well as from maternal and paternal blood. Genetic analysis demonstrated that the placental tumor consisted of only paternal origin, which is consistent with the diagnosis of complete hydatidiform mole.

Increased fibrin/fibrinogen degradation products without increase of plasmin-α2-plasmin inhibitor complex after hepatectomy for hepatocellular carcinoma

To clarify the meaning of increased serum fibrin/fibrinogen degradation products (FDP) in the postoperative period of hepatectomy, blood coagulation and fibrinolysis were studied using recently devised laboratory assays of a group of 30 patients with hepatocellular carcinoma. Twenty of these cases were associated with liver cirrhosis. As a control group, 15 patients with colorectal carcinoma without liver diseases were also selected. In the early postoperative period following hepatectomy, a hypercoagulable state designated as intravascular thrombin generation was confirmed from the finding of increased plasma levels of fibrinopeptide A (FPA). Fibrinopeptide B beta 15-42 (B beta 15-42) in the plasma also increased immediately after the peak of FPA, followed by a gradual decline in B beta 15-42 levels. On the other hand, FDP in the serum increased significantly rather late in the postoperative period following hepatectomy without increased levels of plasmin-alpha 2-plasmin inhibitor complex. However, postoperative increase of fibrin/fibrinogen degradation products-D (FDP-D) was modest and not different from the colectomy group. Therefore, the relevance of intravascular coagulation in the hepatectomy for the patients with liver cirrhosis seems not to be significant, and then such an increase of FDP in the serum seems to be related to other mechanisms.

Appropriate use of fresh frozen plasma after hepatic resection, based on prothrombin time.

肝切除術後のfresh frozen plasma (FFP) の適正な使用基準について肝細胞癌切除66例を2期にわけ検討した. 前期29例にはFFPを制限を設けずに使用し, 後期37例にはprothrombin time (PT) を指標にできる限り使用節減の方向で術後管理を行った. その結果, 後期ではFFPの1人あたり使用総量で前期より約40%節減でき, FFP非使用例は前期2例より後期14例に増加した. 後期にPT延長例が増加したが出血傾向の発生に差はなく, 肝不全などの致命的合併症は前期3例 (10%), 後期2例 (5%) にみられ, いずれも術後1週間以内にPTが15秒を越えた症例であった. 以上の成績から, 凝固因子補充を目的としてFFPを輸注する場合, 術後1週間以内にPTが15秒以上に延長した時使用を考慮すればよいと考える.