A case in which danaparoid sodium was effective for portal venous thrombosis developed after endoscopic injection sclerotherapy for esophageal varices

We report a case of hepatitis C type liver cirrhosis with portal venous thrombosis in which danaparoid sodium was very effective. The patient developed portal venous thrombosis, esophageal ulcer, and esophageal stenosis at the same time after sclerotherapy. Since it was confirmed by abdominal computed tomography that there was no portal venous thrombosis before sclerotherapy, development of the thrombosis was considered to be associated with sclerotherapy. The patient was treated with balloon dilation therapy for esophageal stenosis, and with anticoagulation therapy using danaparoid sodium for portal venous thrombosis. The portal venous thrombosis disappeared 4 weeks after the treatment. Despite the condition of esophageal ulcer being caused by sclerotherapy, the patient was safely treated without any adverse effects and complications, and the clinical course has been good. It was indicated that danaparoid sodium was an anticoagulant unlikely to cause adverse effects such as hemorrhage and might be an effective drug for treatment of portal venous thrombosis.     

The ''mosaic-like'' pattern of portal hypertensive gastric mucosa after variceal eradication by sclerotherapy

The 'mosaic-like' pattern of portal hypertensive gastric mucosa has been evaluated endoscopically in 38 patients referred for elective sclerotherapy, before the first session, after the complete eradication of varices and six months later. Of 38 patients studied, 18 patients exhibited mild, and 20 patients exhibited negative, findings of congestive gastropathy prior to sclerotherapy. Seventeen and 18 patients, respectively, developed aggravated changes of congestive gastropathy after the completion of sclerotherapy (P = 0.003). We consider that obliteration of varices by means of endoscopic sclerotherapy influences the development of gastric congestion changes in the majority of patients. However, further studies are required to relate the direction of blood flow in the portal system as well as the level of portal pressure with the congestive gastropathy findings in such patients.     

Hemodynamic changes in a patient with esophageal varices after endoscopic injection sclerotherapy evaluated by endoscopic color Doppler ultrasonography

A 46-year-old man with alcoholic cirrhosis was admitted to our hospital for treatment of high-risk esophageal varices in February 2000. Images of the esophageal varices, paraesophageal veins and palisade veins were obtained by endoscopic color Doppler ultrasonography (ECDUS) before endoscopic injection sclerotherapy (EIS). Prophylactic EIS was performed six times per week for esophageal varices, and EIS was continued until the esophageal varices were completely eradicated. In July 2002, endoscopy revealed esophageal varices graded as Cb, F1, Lm, and RC(−), and color flow images of the palisade veins (hepatofugal flow), esophageal varices, and a developed paraesophageal vein were obtained with ECDUS. In April 2003, endoscopy showed esophageal varices graded as Cb, F1, Lm, and RC(−), and color flow images of the palisade veins and esophageal varices were obtained using ECDUS. The blood in the palisade veins flowed in an alternate direction on color flow images, and pulsatile waves were delineated at the gastroesophageal junction. In January 2004, endoscopy revealed esophageal varices graded as F0 and RC(−), and pulsatile waves were delineated in the lower esophagus with ECDUS. However, the esophageal varices and palisade veins had disappeared from color flow images. In conclusion, ECDUS was useful for evaluating hemodynamic changes after EIS.     

人体包虫病的超声引导经皮穿刺硬化治疗

本文总结了人体多脏器多部位的包虫病８６例１０９个肿物在超声引导和监视下经皮穿刺硬化治疗的经验。其中，囊型包虫病８３例１０５个肿物，泡型包虫病３例４个肿物。穿刺成功率１００％。穿刺治疗总有效率１００％，（治愈率８３．７２％）。无一例出现过敏性休克、出血、感染等严重并发症。穿刺术后超声随访观察最长的已逾４２个月，平均２３个月，未发现穿刺针道和其它脏器或部位播散移植的任何迹象，亦无一例复发。结果认为，超声引导经皮穿刺硬化治疗肝脾等脏器和腹腔等部位的各型包虫病简便易行，安全实用，创伤甚微，疗效可靠，是一种基本上可替代传统手术疗法的新途径。     

CT引导下穿刺注射乙酸治疗肾囊肿的临床应用

目的：探讨乙酸作为硬化剂治疗肾囊肿的方法和疗效。方法：在CT引导下,用21G穿刺针经皮穿刺对42例单发性肾囊肿抽吸后,注入50%的乙酸行硬化治疗。囊肿直径最大10．5cm,最小3．5cm。注入硬化责4的量约为抽出囊液的1／4左右。术后3～36个月复查“B”超或CT观察其疗效：结果：42例肾囊肿经抽吸并行50％乙酸硬化治疗后,有20例术后出现短暂性肾区疼痛,无1例严重并发症发生。3-36个月经“B”超或CT随访,有效率为951％,其中囊腔消失率为80．9％。结论：50％的乙酸作为硬化剂治疗肾囊肿,疗效好,并发症少,值得临床推广应用.     

Variceal rebleeding: use of drug therapy and endoscopic band ligation

Patients surviving a variceal bleed are at high risk of re-bleeding with a mortality of 25–50% during a 1–2 year follow-up. Several studies and meta-analyses have demonstrated reduced rates of oesophageal variceal rebleeding with the use of β-blockers. However, their use can be limited by contraindications or intolerance to therapy. Other trials have shown that addition of nitrates may improve the efficacy of β-blockers in prevention of variceal re-bleeding. Endoscopic variceal band ligation (VBL) has been shown in meta-analyses to decrease the rates of rebleeding and mortality compared with endoscopic sclerotherapy. Studies comparing combined drug therapy with VBL have shown similar rebleeding rates although there is a suggestion that survival may be higher in those given drug therapy. Recent data suggest that combined VBL and drug therapy reduces the risk of rebleeding from oesophageal varices compared with either therapy alone; however there appears to be no reduction in overall mortality.