Massive spouting bleeding from chronic stasis ulceration caused by arteriovenous communication of the lower extremity

We report a case of massive bleeding from a varicose vein in a calf. A 56-year-old man was brought into the emergency unit of our hospital with massive bleeding from an ulcer on his left calf. A duplex scan and arteriography revealed arteriovenous communication at the site of stasis ulceration. After primary hemostasis, coil embolization of the feeding artery to the arteriovenous communication was successfully performed, followed by stripping of the greater saphenous vein. Careful attention thus needs to be paid to arteriovenous communication that can cause life-threatening bleeding from stasis ulceration. Coil embolization of the feeding arterial branch can safely and effectively treat this disease.     

Serotonin syndrome from the interaction of cyclobenzaprine with other serotoninergic drugs

Serotonin syndrome is a potentially lethal adverse drug reaction that may occur in patients taking proserotoninergic medications. Drug interactions are often responsible for the causation of this syndrome. We report two cases of severe serotonin syndrome induced by the administration of cyclobenzaprine in postoperative patients already receiving another proserotoninergic drug (phenelzine in one case and duloxetine in the other). In both cases, symptoms of autonomic instability and severe agitation started within hours of initiation of cyclobenzaprine and fully resolved within 3 days after discontinuing the proserotoninergic drugs. We conclude that cyclobenzaprine should be used with extreme caution in patients receiving other serotonin-enhancing drugs; these patients should be closely monitored for manifestations of serotonin syndrome.     

Case in which renal function improved following stent-graft placement in the aorta two months after the onset of stanford type B acute aortic dissection

A 48-year-old man was admitted to the Department of Cardiovascular Surgery in our hospital after developing Stanford type B acute aortic dissection with a patent false lumen in July 2008. Conservative treatment involving rest and antihypertensive therapy was provided following admission. Urine volume decreased from day 9, and serum creatinine increased to 7.7 mg/dL. As it was suspected that the reduced renal blood flow was caused by progression of aortic dissection, contrast-enhanced computed tomography (CT)was performed. The left kidney showed reduced enhancement and the right kidney was heterogeneously enhanced. The dissection had extended to the left renal artery, and the reduced renal blood flow caused by narrowing of the left renal artery was thought to have caused the renal dysfunction. As elevated urea nitrogen and serum creatinine levels and hyperkalemia persisted, hemodialysis was performed a total of four times. Although the patient was subsequently withdrawn from dialysis, he continued to display severe renal dysfunction and was transferred to our department on day 28 for the treatment of renal failure. Conservative treatment was continued, but the maximum diameter of the thoracic aorta gradually increased, and stent placement at the entry of aortic dissection was indicated. On day 86, two stent-grafts were placed for entries at the distal site of the descending aorta and the distal site of the aortic arch. Postoperative abdominal contrast-enhanced CT showed expansion of the true lumen, and blood flow and contrast enhancement improved in both kidneys. Postoperatively, serum creatinine gradually decreased, improving to 1.16 mg/dL on day 96. Renography in the third month after stent-graft placement showed improved renal function in both kidneys. These findings suggest that even at approximately 2 months after the onset of acute renal failure associated with aortic dissection, renal function can be improved by restoring blood flow in the renal arteries.     

The Salivary Gland and Systemic Health: Towards the Creation of Salivary Gland and Health Medicine

Salivary glands are intimately connected with the entire body via the nervous system and blood vessels, yet few studies have documented the effects of the salivary glands on the health of the whole body, although saliva has often been reported to possibly contain promising biomarkers of systemic disease states, including cancer. We therefore propose that the investigation of the effects of the salivary gland on the whole body and vice versa could introduce a new field of study, i.e., “salivary gland and health medicine.” This review examines data from novel studies on “salivary gland and health medicine” that were carried out by 3 different research groups.