vitamin-k-semiquinone-radical and Gallstones

An 85-year-old woman with a diagnosis of choledocholithiasis due to common duct stones gradually developed severe coagulation dysfunction over the course of 27 days after hospitalization. Initial clinical findings were fever, general malaise, and obstructive jaundice. She was treated with fasting, and received cephem antibiotics containing N-methyl-thio-tetrazole. Because the common duct stones were not removed endoscopically, cholecystectomy was scheduled. Coagulation on admission was normal, but gradually became impaired. On the scheduled day of the operation, 27 days after hospitalization, coagulation [both prothrombin time (PT) and activated partial thromboplastin time (APTT)] were severely impaired PT, < 10%; PT-international normalized ratio, 6.29; and APTT, 71.6 s. No other abnormalities were identified. Surgery was postponed and antibiotics were discontinued. Simultaneously, administration of vitamin K was initiated. Six days after starting vitamin K, coagulation dysfunction had resolved and the surgery was safely performed under general anesthesia combined with thoracic epidural anesthesia. Care is warranted regarding coagulation dysfunction due to vitamin K deficiency in patients with hepatobiliary disease treated by fasting and antibiotics.

Topics: Aged; Aged, 80 and over; Blood Coagulation Disorders; Cholecystitis; Female; Gallstones; Humans; Vitamin K

We used a catheter passing through the papilla duodeni under the view of endoscope, with persistent perfusion system and transducer, to measure the pressure and contraction frequency of sphincter of Oddi (SO) in 10 healthy persons and 20 patients. Meanwhile, we compared the effect of Buscopan, Nitrostat and Vitamin K3 on the pressure and contraction frequency (CF). SO basal pressure (BP) in healthy group was 5.21 +/- 1.61 kPa (mean +/- s), SO peak pressure (PP) 8.21 +/- 1.34 kPa and CF 6.14 waves/min. In the group of peripapillary fistula, SO pressure decreased significantly and CF slowed down greatly. In comparison with the healthy group, SO pressure and CF in the group of gallbladder stone, choledocholithiasis and pancreatic diseases did not show any change of statistic significance. Intravenous injection of Buscopan could decrease SO peak pressure and BP remarkably. Sublingual administration of Nitrostat and intramuscular injection of Vit K3 could reduce SO PP markedly, SO BP didn't change statistically. It was also showed that spheric and semi-spheric papillae had higher pressure than the flat ones (P less than 0.001).

Topics: Adult; Aged; Butylscopolammonium Bromide; Cholelithiasis; Dipyrone; Drug Combinations; Female; Gallstones; Humans; Male; Manometry; Middle Aged; Nitroglycerin; Pancreatic Diseases; Parasympatholytics; Sphincter of Oddi; Vitamin K