Gastrointestinal Endoscopy under Sedation with a Continuous Infusion of Propofol / 대한소화기내시경학회지

BACKGROUND AND AIMS: Propofol is a short-acting intravenous sedative-hypnotic agent that can be used as a hypnotics for upper gastrointestinal endoscopy. A study was conducted to evaluate the effectiveness and safety of propofol as a hypnotic agent for upper gastrointestinal endoscopy. METHODS: From June to October 1998, twenty eight patients undergoing upper gastrointestinal endoscopy were to receive propofol. Vital signs and peripheral oxygen saturation (SpO2) were monitored by pulse oximetry during continuous infusion of propofol. Propofol (1% solution) was initially infused by 26.7 mg/kg/hr until loss of eyelash reflex and then titrated to 6-10 mg/kg/hr according to the patient's response and vital sign. Propofol infusion was discontinued while the endoscopic fiber was removed. Recovery time was defined from discontinuation of infusion to positive Romberg test. Evaluation was made from the endoscopists' assessment, patients' satisfaction, patients' recall of the procedure, and consciousness of the patients. RESULTS: It was discovered that systolic, diastolic pressure and heart rate were significantly decreased, compared to control group. But clinically significant changes were not found. Apnea did not exist. And the respiration rate was significantly increased during propofol infusion. Peripheral oxygen saturation (SpO2) was transiently decreased during endoscopy. 14 patients (50%) complained of transient dizziness. Pain and redness over the infusion site was not found. The mean total dose of propofol was 133.6 mg. The mean infusion time of propofol was 6.2 minutes. Mean response and recovery time was 3.7 2.1, 20.9 5.4 minutes. Endoscopists' assessment and patients' comfort for endoscopy were satisfactory. When we asked 28 patients about willingness to undergo the same procedure in the future, 27 patients (96.4%) agreed. Degree of amnesia after examination revealed total amnesia in 27 patients (96.4%), partial amnesia in 1 patients (3.6%), and recall was not. CONCLUSIONS: Propofol has beneficial effects as hypnotic for upper gastrointestinal endoscopy without significant alteration in cardiopulmonary parameters. Patients' and endoscopists' assessment is good. This suggest that propofol may be used more frequently as a kind of premedication, especially in the cases of repeated endoscopy.

Reflux Esophagitis after Cure of Helicobacter pylori Infection: Report of two cases / 대한소화기내시경학회지

Helicobacter pylori infection causes chronic gastritis and its well documented con- sequences are peptic ulcer disease and gastric neoplasia. As duodenal ulcer is often associated with gastroesophageal reflux disease and antral gastritis is a frequent finding in patients with reflux disease, H. pylori infection may be a common cause of both conditions. Recent studies reveal that H. pylori has no role in the pathogenesis of reflux esophagitis. Furthermore, there are some arguments on whether H. pylori infection may have a protective role in reflux esophagitis. We have experienced two cases of reflux esophagitis after cure of H. pylori infection. H. pylori eradication therapy was performed in two patients who have gastric and/or duodenal ulcer with omeprazole and two anti-biotics (clarithromycin and amoxicillin). After cure of H. pylori infection, reflux esophagitis was demonstrated in these patients by endoscopy.

Non-Invasive Early Assessment of Successful Reperfusion in Acute Myocardial Infarction Using Serial Plasma Troponin-T and Troponin-T Rapid Assay Kit

BACKGROUND: An earlier index of reperfusion after thrombolytic therapy in patients with acute myocardial infarction is desirable to determine whether additional therapy is necessary to salvage the myocardium. Cardiac troponin-T has been developed as a new myocardial specific marker for myocardial injury and has been used for early assessment of reperfusion therapy. This study was performed to investigate the utility of cardiac troponim-T for assessment of reperfusion therapy using serial serum troponin-T and the rapid assay kit. METHODS: The study was comprised of 70patients(M/F : 64/6, mean age 56+/-2 year) with acute myocardial infarction and reperfusion therapy was initiated within 6 hours after the onset of symtoms. Blood samples for CK and troponin-T were taken before thrombolysis and then 60, 90 munutes, 3, 6, 12, 24, 48, and 72 hours after thrombolysis. We compared successful reperfusion index of troponin-T [successful Reperfusion Index : troponin-T90 or 60min-base> or =0.3 or 0.2ng/ml, Rapid Assay Kit(n=40) : Base(-), 90 or 60min(+)] with the real reperfusion that was assessed by coronary angiogram(TIMI grade 3 at 90 minutes after thrombolysis) or clinical reperfusion index defined as early peak of cardiac enzyme(within 12 hours for CK and within 24 hours for cardiac troponin-T). RESULTS: 1) The cardiac troponin-T and CK activity in patients with successful reperfusion showed early peak within 12 hours after thrombolysis was initiated. 2) Successful reperfusion by angiography or clinical reperfusion index were shown in 64(91%) of 70 patients with thrombolysis. 3) The sensitivity, specificity, positive and negative predictive value, and predictive accuracy for detecting reperfusion using a threshold value of 0.2ng/ml of delta troponin-T at 90 minutes after thrombolysis were 95%, 83%, 98%, 63%, and 96% respectively. 4) The sensitivity, specificity, positive, and negative predictive value, and predictive accuracy of successful reperfusion index using the rapid assay kit at 90 minutes after thrombolysis were 97%, 100%, 100%, 67%, and 97% respectively. CONCLUSIONS: The successful reperfusion index using delta troponin-T> or = 0.2ng/ml and the rapid assay kit at 90 min after thrombolysis are simple and usful for early assessment of reperfusion therapy. Thus bedside monitoring for cardiac troponin-T is now possible to improve the decision making process as to whether rescue angioplasty after thrombolysis is necessary to salvage the myocardium.

Acute Myocardial Infarction in Young Man with Nephrotic Syndrome

The association between nephrotic syndrome and intravascular coagulation has been known for more than a century, but it was not until 1948 that a thrombotic diathesis in nephrotic patients was proposed. The prevalence of thrmbo-embolic complications is much higher in adult patients. Deep vein thrombosis of the leg is the most common complications in nephrotic adult and was responsible for one-third of the thrombo-embolic complications of nephrotic children. Arterial thrombosis occurs less frequently and is seen primarily in childern. We present a case of acute anterior myocardial infarction in a young man with nephrotic syndrome, secondary to minimal change glomerulonephritis, in which thrombosis of the proximal left anterior descanding artery was the actual cause of acute myocardial infarction.