Natsuo Suzuki

Experimental study on the effects of sclerosants for esophageal varices on blood coagulation, fibrinolysis and systemic hemodynamics

SummaryThe effects of five sclerosants used for treating esophageal varices on blood coagulation and fibrinolysis, systemic hemodynamics, and vascular endothelial cells were studied in mongrel dogs. With each sclerosant, hemolysis and a decrease in the platelet count were observed. Changes in the blood coagulation system occurred immediately after sclerosant administration. Prolongation of the PT and APTT and decreases in fibrinogen and ga2-PI were seen in the thrombin (TH), sodium tetradecyl sulfate (STS), and ethanolamine oleate (EO) groups. Polidocanol (PO) and absolute ethanol (ET) had less pronounced effects on these systems. A transient decrease in the cardiac index (CI), pulmonary artery pressure (PAP) and pulmonary artery resistance (PAR) was observed with the administration of the sclerosants, especially in the TH and STS groups. Excessive vascular endothelial damage was observed in the ET group, marked damage was seen in the EO and STS groups and slight damage was recorded in the PO and TH groups.

A CASE OF OBSTRUCTIVE ILEUS CAUSED BY ENDOMETORIOSIS IN THE ILEUM

A 45-year-old woman seen at the department because of a right lower quadrant abdominal pain at menstruation which started about 3 years before. Abdominal X-ray film revealed intestinal obstruction. Obstructive ileus following appendectomy was suspected and the patient was operated on. During surgery, adhesive ileus at the terminal ileum was detected. Ileocecal resection was performed. Pathological diagnosis was made with endometriosis in the ileum, Bowel endometriosis causing intestinal obstruction is rare. It presents difficulty in pre-and intra-operative diagnosis. In a review of the literature, 28 cases including this case have been reported in Japan. It was characteristic of this disease that seven cases (25%) had a previous history of endometriosis, and 14 cases (50%) developed symptoms at menstruations. Those symptoms included abdominal pain, consti-pation, melena, diarrhea, and vomitting. In this case, the patient also complained of abdominal pain and constipation at menstruations. Entertaining of these characteristics, careful attitude for history taking is very important to get the correct diagnosis.