Abstract
An investigation has been done on characteristics of fibrinolytic activities in twelve cases of peptic ulcer with excessive bleeding in comparison with twenty four non-excessive bleeding cases. The former involves five cases of gastric ulcer, three cases of duodenal ulcer and four cases of upper gastrointestinal haemorrhage. while the latter consists of twelve cases of gastric ulcer and twelve cases of duodenal ulcer.
The investigation has revealed the following three characteristics of fibrinolytic activities in peptic ulcer with excessive bleeding.
1. Decreased plasma fibrinogen level.
2. Increased plasminogen activator activity was disclosed by means of Astrup's Fibrin Plate.
3. Both activator and inhibitor activities were increased and remained at high energy equilibrant in view of activator-inhibitor ratio.
These three characteristics are believed to indicate that fibrinolytic activities were increasing at the time of the investigation, or a situation as a result of fibrinolytic activities which had been enhancing.
It is considered that fibrinogenolysis is responsible for this decreased plasma fibrinogen level. It is also believed that the increased plasminogen activator activities were induced by general fibrinolytic response followed by bleeding or secondary fibrinolytic response to thromboplastic material which flowed into blood stream from tissues through injured blood vessels.
In spite of foregoing, however, such an increased general fibrinolytic activity and locall fibrinolytic activity might have promoted bleeding at “Locus minoris” such as pepticc ulcer.
In either case, changes of the fibrinolytic activitiy are related to strengthen or weaken defense factor of mucous membrane, and through these effects, the fibrinolytic activity is believed to play a significant role of pathogenesis in bleeding peptic ulcer. It should be a factor which has influence upon healing process of peptic ulcer.
In view of this, a standard procedure pertaining to the use of anti-plasmin drugs should be established after complete investigation on both fibrinolysis and coagulation.
Before this gist is closed, it is strongly recommended that Sp-Eug, L. A. of Astrup's Fibrin Plate should be utilized for assay since this method has best reflected the process of ulceration and bleeding.
