The role of circulating somatostatin (SRIF) in triglyceride (TG) homeostasis was evaluated in fasting and postprandial lymph of the canine thoracic duct. Cyclic SRIF at a very low, near physiologic (50 ng/min), and pharmacologic (5 μg/min) doses was infused into the portal or the femoral vein, and lymph was collected every 10 min through a cannula inserted into the duct under neuroleptanalgesia. The intraportal (IP) and intrafemoral (IF) SRIF infusion, but not saline infusions, significantly and almost identically reduced the rates of fasting lymph flow to levels of 87% and 91% of the preinfusion values, respectively, at a dose of 50 ng/min, and to 78% and 80%, respectively, at both rates at a dose of 5 μg/min. The attenuating effect of the IP and IF SRIF infusions at both rates upon lymph flow was completely abolished by vagotomy at the diaphragmatic level. The flow rate, TG concentration, and TG content (flow × concentration) of lymph obtained 3 h after a fat- and protein-rich meal ingestion were significantly and almost identically reduced during the IP and IF SRIF infusions at 50 ng/min, but not during saline infusions. Greater attenuation of these parameters was observed with 5 μg/min infusions, regardless of the route of administration. These results indicate that SRIF in near physiologic as well as pharmacologic doses can inhibit lymph flow after traversing the liver in the presence of the vagus nerve. They suggest the the other splanchnic organs may have a physiologic influence upon TG entry from the gut through alterations of dynamics of the splanchnic lymph system.

A 70-year-old womanwith poorly controlled diabetes mellitus was admitted because of persistent remittent fever. Soon a liver abscess was detected as the cause of the fever by ultrasonography, and antibiotic therapy was started. However, suddenly serious dyspnea with chest and back pain developed. The morbid condition was definitely diagnosed as septic pulmonary emboli (SPE) with pulmonary per fusion scan. It should be recognized that liver abscess can be a latent focus of systemic metastatic complications such as SPE, and not only early detection but also prompt appropriate drainage of liver abscesses is essential. (Internal Medicine 34: 42-45, 1995)

SummaryA 59-year-old woman was admitted to our hospital for the treatment of an acute anterior myocardial infarction. She had a history of uncontrolled diabetes mellitus, hypertension, hyperlipidemia, obesity, and smoking. Coronary angiography revealed 90% stenosis with spontaneous dissection in the proximal portion of the left anterior descending artery. At this time, heparin was initiated for the first time. Although direct stenting (Be-stent, 3.0-18 mm) was performed for the culprit lesion, coronary dissection occurred at the left main trunk and additional stenting (Multi Link ZETA stent 3.5-15mm) was performed for the left main trunk. Soon after stenting, repetitive stent thrombosis occurred. Aspiration of the thrombus using an aspiration catheter was ineffective and repetitive angioplasty and intraaortic balloon pumping were required. Although we used 17,000 units of unfractionated heparin during the intervention, the activated coagulation time (ACT) was not prolonged (157 seconds). In the coronary care unit, the ACT and activated partial prothrombin time (aPTT) were not prolonged despite the use of large amounts of heparin (69,000 units in 2 days). Protein-S, protein-C, and hepaplastin testing were within normal limits and heparin-platelet factor IV complex antibody was not detected. In the acute phase, a decrease in the antithrombin III activity (65%) was noted and with administration of argatroban, prolongation of the aPTT was achieved. In the chronic phase, the decrease in antithrombin III activity and heparin resistance had improved spontaneously. It is important to recognize the existence of transient decreases in antithrombin III activity in the acute phase of myocardial infarction. (Int Heart J 2009; 50: 111-119)

An 81-year-old man was admitted to the hospital with a fever and loss of appetite. After treatment with piperacillin sodium (PIPC), the patient exhibited thrombocytopenia, hemorrhagic colitis, and drug-induced skin eruption. On the fifth day after PIPC induction, he further experienced neurological abnormalities, such as disorientation and confusion, renal dysfunction, and microangiopathic hemolytic anemia (MAHA). The patient was diagnosed with thrombotic thrombocytopenic purpura (TTP) on the basis of thrombocytopenia, MAHA, renal dysfunction, fever, and neurological abnormalities. Infusion of fresh-frozen plasma was initiated for treatment. His condition improved markedly after this treatment. It is rare for TTP to be accompanied with hemorrhagic colitis and skin eruption. These symptoms were induced by PIPC and were successfully treated with plasma infusion.

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