Takao Higa

Successful management of ruptured duodenal varices by means of endoscopic variceal ligation: report of a case.

Less-invasive therapies such as endoscopic injection sclerotherapy and endoscopic variceal ligation are being used increasingly in the management of gastroesophageal varices caused by portal hypertension.1 Balloon-occluded retrograde transvenous obliteration recently has been developed mainly for management of gastric fundal varices.2 However, no definitive conservative therapy for duodenal varices has been established, and surgical intervention still is used in emergency situations because of the lack of alternatives.3,4 Unsuccessful management of ruptured duodenal varices may result in death.5 We herein report the first known case of a ruptured duodenal varix successfully managed with endoscopic variceal ligation.

Limitations of Exogenous L-Arginine in Exerting a Cytoprotective Effect on Hepatic Ischemia/Reperfusion Injury

Abstract: To test whether or not the L -arginine/nitric oxide (NO) pathway induces a protective effect, we investigated the effect of exogenous L -arginine on hepatic ischemia/reperfusion (I/R) injury, using ex vivo perfusion of the isolated rat liver. The rat liver was removed and preserved in cold saline for 60 min, followed by 120 min of reperfusion with oxygenated perfusate at 37°C. Either 600 mg/kg of L -arginine (groups 1 and 4), D -arginine (group 2), N G -nitro- L -arginine methyl ester ( L -NAME) (group 3), or saline (group 5) were administered through the portal vein starting from 5 min before reperfusion to 5 min after reperfusion. In group 4, 600 mg/kg of L -NAME was preadministered at 10 min prior to the administration of L -arginine. The intrahepatic nitric oxide (NO) levels showed only a temporal elevation (227% ± 70% of the pre-reperfusion levels at 5 min) after reperfusion in group 1. Pretreatment with L -NAME suppressed the elevation of the NO levels immediately after reperfusion in group 4. The lactate dehydrogenase release to the effluent perfusate significantly decreased and the histological findings showed that the sinusoidal damage observed after reperfusion was mitigated in group 1 more than in the other groups. These results thus suggest that exogenous L -arginine produced a relatively small amount of NO and therefore resulted in a slight decrease of hepatic I/R injury.

Surgical Treatment of a Sigmoid Volvulus Associated with Megacolon: Report of a Case

Abstract Sigmoid volvulus occurring concomitantly with megacolon is an uncommon cause of bowel obstruction, and various approaches to treatment have been proposed. We report herein a case of sigmoid volvulus with megacolon that was successfully treated by elective surgery following endoscopic reduction during the same hospital stay. A 70-year-old woman was admitted to our hospital with abdominal pain, distension, and severe constipation. Physical examination, plain abdominal X-ray, and barium enema confirmed a sigmoid volvulus and further examinations revealed concomitant megacolon. An elective sigmoid colectomy was performed following successful endoscopic decompression. The postoperative course was uneventful and there was no residual colonic dysmotility. Histologically, no aganglionic tissue was observed in the resected specimen.