Tomoyuki Taniguchi

A case of ruptured duodenal varices and review of the literature

The incidence of duodenal varices is exceedingly rare. A case of bleeding duodenal varices located in the third portion of the duodenum, secondary to idiopathic portal hypertension, which was successfully treated by surgery, is presented herein. Diagnosis was suspected at superior mesenteric angiography and was subsequently confirmed by endoscopy. A review of the literature reveals only 105 such cases in the world. While the duodenal bulb is the most common site of duodenal varices, the second portion of the duodenum appears to be the next most common site but duodenal varices in the other portions are extremely rare. From all of the possible causes of duodenal varices, liver cirrhosis remains the predominant etiological factor in 31 cases.

Platelet size and function in septic rats: changes in the adenylate pool.

Cecal ligation and puncture (CLP) were performed in rats. After 4 hr (early sepsis) and 16 hr (late sepsis), platelet morphology and function were studied. At 16 hr, platelet counts for the CLP group were significantly lower than for the sham-operated control group. Low maximum aggregation rates (MAR) and decreased platelet counts were elicited in platelet-rich plasma with 4 M ADP and 2 micrograms/ml collagen. However, with platelet counts equalized, MAR for the CLP group increased significantly, especially after 16 hr. The platelet-large cell rate and platelet distribution width decreased temporarily at 4 hr, then rose significantly at 16 hr. No significant changes were observed in the mean platelet volume after 4 hr, but there were significant increases after 16 hr. Total adenine nucleotide (TAN) levels within the platelets rose significantly in the CLP group, suggesting the appearance during the late sepsis of large, heavy platelets or adenine nucleotide-rich platelets. The platelet adenylate pool was divided into granular and cytoplasmic fractions, respectively characterized by ADP and ATP increases. However, no septicemia-related differences were noted in the degree of binding between goat antirat fibrinogen and platelet surface glycoprotein IIb/IIIa complex. Internal environment changes in the platelets indicated that during septicemia hyperfunctional or hypersensitive platelets with a latent capacity for active aggregation and release appeared in the circulation. Hypercoagulability in septicemia involves activation of coagulation factors, stimulation of the coagulation cascade, volume changes accompanying increased platelet TAN content, and changes in AN distribution in the two pools. These findings significantly increase our understanding of the transition from the prethrombotic state to thrombosis in septicemia.

Thrombotic thrombocytopenic purpura associated with transient chromosomal aberrations: successful treatment with plasma exchange.

A 69-year-old woman with typical thrombotic thrombocytopenic purpura is reported, who was treated successfully by plasma exchange. An initial chromosomal analysis of peripheral blood lymphocytes revealed abnormal patterns of 45, XO/46, XX/47, XXX; a second analysis showed 45, XO/46, XX/47, XXX/47, XX + 21, and a third, performed in remission, showed a normal pattern. Skin fibroblasts showed a normal pattern even during the acute disease. The association of transient chromosomal aberrations and thrombotic thrombocytopenic purpura might be related to a viral infection.

[A case of Hughes-Stovin syndrome associated with Behçet's disease].

3回にわたり大量の喀血を繰り返した31才男性のBehcet病患者に合併したHughes-Stovin症候群を経験した.血管造影検査にて肺動脈瘤と下大静脈狭窄を認めたことより本症候群と診断した.それまで行っていた抗凝固療法を中止し, colchicineとステロイド薬を併用したところ,喀血は軽快し寛解を得た. Hughes-Stovin症候群はきわめてまれな症候群であり,その報告例は自験例も含めわずか20例にすぎない.多くは喀血により死亡していた.最近本症候群とBehcet病との関連性がとりざたされており,本症例もそのような1例であると考えられる.