Yoshimi Kitagawa

Angiodysplasia of the appendix.

Angiodysplasia of the gastrointestinal tract is thought to be one of the most common causes of lower gastrointestinal bleeding in the elderly, and, in the majority of cases, lesions are located in the cecum or ascending colon. The authors report an extremely rare case of appendicular angiodysplasia. A 76-yr-old woman was hospitalized with massive recurrent red anal bleeding. Selective superior mesenteric arteriography revealed an extravasation of contrast material from the appendicular artery, and this finding proved to be bleeding from an angiodysplasia of the appendix. An appendectomy was performed, and anal bleeding did not recur postoperatively. A review of the literature revealed this to be an extremely rare case of angiodysplasia.

THE EFFECTS OF INTRAVENOUSLY INFUSED CATECHOLAMINES ON HEPATIC BLOOD FLOW IN CONSCIOUS DOGS WITH EXPERIMENTAL OBSTRUCTIVE JAUNDICE

This study was conducted to examine how the effects of dopamine and dobutamine on hepatic blood flow were influenced by obstructive jaundice in a conscious canine model. Prior to biliary obstruction, portal venous blood flow (PVF) increased in response to the infusion of either dopamine or dobutamine: dopamine infused at 8 μg/kg per min produced an increase of 19±0% in PVF, while dobutamine infused at 16 μg/kg per min produced an increase of 30±2%. Although hepatic arterial blood flow (HAF) decreased dose-dependently in response to the infusion of dopamine, no significant change was observed in HAF in response to any dose of dobutamine. Obstructive jaundice attenuated or completely abolished the PVF-increasing effect of dopamine, whereas it did not significantly alter the effect of dobutamine on hepatic blood flow. In dogs with obstructive jaundice, dopamine at 16 μg/kg per min produced a decrease of 17±3% in PVF. These findings suggest that dobutamine is more effective than dopamine for increasing hepatic blood flow in patients with obstructive jaundice.

Effects of Prostaglandin E1 on Hepatic Blood Flow in Conscious Dogs with Chronic Biliary Obstruction

To evaluate the effects of prostaglandin E₁ (PGE₁) on the hepatic circulation in cholestasis, hepatic arterial blood flow (HAF), portal venous blood flow (PVF), cardiac output, and heart rate during PGE₁ infusions were investigated before and 2 weeks after biliary obstruction in conscious dogs by a transit-time ultrasonic flowmeter. In the control period, HAF and PVF increased dose dependently with the infusion of PGE₁ from 0.05 to 0.5 µg/kg/min. During the biliary obstruction period, a lower dose of PGE₁ increased HAF and PVF. The plasma concentration level of PGE₁ during the infusion of PGE₁ was significantly higher at each dose in the cholestatic animals. These results suggest that the metabolism of PGE₁ is attenuated by cholestasis. Plasma PGE₁ concentrations should be useful in deciding the optimal dose of PGE₁.

Selection of Nonessential Intravenous Contrast Enhanced-Computed Tomography for Diagnosing Acute Appendicitis

はじめに: 急性虫垂炎の診断にCTを用いることで診断はより確定的になり, 経静脈的造影CT(intravenous contrast-enhanced CT; 以下, IV-CTと略記)は汎用されるようになってきた.本研究の目的は, IV-CTの適応を明らかにし, 不要なIV-CTを削減することである. 適応について, 発症から初診までの時間を加味して検討した. 方法: IV-CTは, 右下腹部痛を有する症例あるいは自発痛がなくても理学検査所見を右下腹部に認める症例に対して行った. 理学検査所見が詳細に記録され, 初診時に血液検査およびIV-CTを施行し, 検により(1)半日未満(半日群), (2)半日以上1日未満(単日群), (3)1日以上(複日群)の3群に分け, Blumberg徴候, 筋性防御の有無, 体温, 白血球数, 査後24時間以内に虫垂切除術を行った連続した171例を対象とした. 発症からの時間CRP値を解析した. IV-CT所見においては虫垂腫大の有無と, 虫垂腫大を含む5項目(虫垂腫大・糞石・腹腔内の液体貯留・盲腸または上行結腸の全周性肥厚・小腸麻痺像)の陽性所見数を解析した. 結果: III筋性防御の陽性率は単日群と複日群の虫垂炎症例で有意に高かった. IV-CT上の虫垂腫大は各群内の虫垂炎症例で有意に認めた. IV-CTの陽性所見は複日群で有意に多く認めた. その他の項目は, 各群内において有意差を認めなかった.考察: 発症から初診まで半日以上経過し筋性防御を認めた場合, 虫垂炎である確率が高くIVCTを省略できる可能性が示唆された.