Anesthetic Management of a Patient with HTLV-1 Associated Myelopathy and with Congenital Left Pulmonary Hypoplasia.

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  • 先天性左肺形成不全症を伴ったＨＴＬＶ‐Ｉ　ａｓｓｏｃｉａｔｅｄ　ｍｙｅｌｏｐａｔｈｙ患者の麻酔経験

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Abstract

We experienced two surgical cases with hemostatic disorder in the preoperative period. Prothrombin (PT) activity was decreased in both patients, while activated partial thromboplastin time, bleeding time, fibrinogen antigen and D-dimer were normal. There was no disorder in the intrinsic pathway, common pathway, platelets and fibrinolysis. It was suspected that these coagulopathies were caused by inhibition of the extrinsic pathway in the coagulation system. In order to check the extrinsic pathway, a hepaplastin test (HPT) was performed and showed a decreased value. These findings suggested that F VII which is vitamin K-dependent coagulation factor, should be decreased. Vitamin K1 (10mg) was intravenously administerd, PT activity and HPT increased to within the normal range during the preoperative period. And PIVKA-II has increased when Vitamin K1 was not yet given. Both patients, therefore were diagnosed as having vitamin K deficiency-induced coagulopathy. Vitamin K deficiency in patients are considered to be caused by cephem antibiotics containing N-methyl-thiotetrazole and no oral intake of food for a few days preoperatively. The patients did not develop postoperative bleeding at all. In the case of hemostatic disorder, the diagnosis of coagulopathy as well as control of the hemostasis is still important in preoperative anesthetic management.

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