A Huge Gastric Bezoar That Was Removed by Endoscopic Combination Therapy with an Argon Plasma and Coca-Cola Injection / 대한소화기내시경학회지

Bezoars are collections or concretions of indigestible foreign material in the gastrointestinal tract. In the past, the most common method for the treatment of bezoar was surgical management. The current treatment methods for bezoars include chemical dissolution and endoscopic lithotripsy using biopsy forceps and, snare, electrohydraulic lithotripsy and laser. Cases of endoscopic fragmentation of gastric bezoars using an argon plasma and dissolution of gastric bezoars with Cola have recently been described, but it took a long time in those cases to remove a bezoar by a single method. Moreover, fragmented, residual bezoar-related complications sometimes occurred. We report here on a case of a 35-year-old man with a 10x8x8 cm sized huge gastric bezoar that was successfully removed by combination therapy using an argon plasma and Coca-Cola injection. Compared with the previous single method, combination therapy using an argon plasma and Coca-Cola injection shortened the procedure time and reduced the complications related to a fragmented, remaining bezoar.

Two Cases of Foreign Body-induced Esophageal Perforation That Were Treated by Endoscopic Clipping and Non-surgical Management / 대한소화기내시경학회지

Perforation of the esophagus is a deadly injury that requires careful management if the patient is to survive. Prompt recognition and proper treatment of esophageal perforation may avert death or minimize complications. Esophageal perforation might be followed by mediastinitis, broncho-esophageal fistula, pneumomediastinum, peritonitis and empyema. Although primary surgical repair is the mainstay of treatment, non-surgical management can be attempted in selected patients. Endoscopic closure of an esophageal perforation with metallic clips and conservative therapy has recently been reported. We describe here two patients with esophageal perforation and pneumomediastinum that were caused by fish bones. One was completely closed by endoscopic clipping and the other was not. Non-surgical management that was made up of parenteral nutrition and antibiotic therapy produced the same successful outcomes in these two cases.

Anesthetic experience for orthopedic surgery on a patient with Glanzmann's thrombasthenia refractory to platelet transfusion: A case report / 대한마취과학회지

Glanzmann's thrombasthenia is an autosomal recessive bleeding disorder caused by qualitative or quantitative abnormalities of the platelet glycoprotein IIb/IIIa (GP IIb/IIIa), which can lead to excessive bleeding. Glanzmann thrombasthenia is associated with clinical variability, with some patients only having minimal bruising and others having frequent, severe and potentially fatal hemorrhages. Platelet transfusions, which used to be the standard treatment, may lead to the development of antibodies to HLA and/or GPIIb/IIIa, thereby rendering future transfusions ineffective. Glanzmann's thrombasthenia can be a severe hemorrhagic disease; however, the prognosis is excellent with careful supportive care. In this case, administering allogenic plateletpheresis to patients with Glanzmann's thrombasthenia who were refractory to platelet transfusions was found to be successful during bone surgeries.

Intramural Duodenal Hematoma following Endoscopic Epinephrine and Thrombin Injection for Bleeding Duodenal Ulcer in a Geriatric Patient with a History of Anticoagulant Drug Use / 대한소화기내시경학회지

Intramural duodenal hematoma is a rare injury of the duodenum due mainly to blunt abdominal trauma and, less commonly, a hematologic disorder, anticoagulant drug use and post-therapeutic endoscopy. Intramural duodenal hematoma following endoscopic intervention is even rarer. Patients usually present with gradual onset of vomiting and abdominal pain approximately 48 h post-injury. The hematoma usually resolves in 1~2 weeks with conservative therapy. Surgery is usually reserved for patients with suspected duodenal perforation, bile or pancreatic duct compression and inadequate resolution of the hematoma after 1~2 weeks of conservative therapy. We describe a patient with a history of anticoagulant drug use who developed intramural duodenal hematoma after endoscopic hemostasis of a bleeding duodenal ulcer. Conservative therapy produced a successful outcome.

Comparison of hydromorphone and fentanyl administered by lumbar epidural as patient-controlled analgesia after total knee arthroplasty

BACKGROUND:Hydromorphone is a semi-synthetic opioid that has recently been used for the control of acute and chronic pain.It has been reported that epidural infusion of hydromorphone provides rapid onset of analgesia and a lower incidence of side effects than morphine.However, comparative studies of hydromorphone and lipophilic opioids such as fentanyl are rare.Therefore, we compared the analgesic effects and side effects of hydromorphone infused epidurally with fentanyl in patients who underwent total knee arthroplasty. METHODS:In a randomized, double-blind manner, 79 patients (ASA I-III, aged 60?75) underwent total knee arthroplasty and were provided with patient-controlled epidural analgesia (PCEA) using a lumbar spinal/epidural-combined technique. Group HR (n = 39) received epidurally administered hydromorphone (4microg/ml) with 0.1% ropivacaine, while group FR (n = 40) received epidural fentanyl (2microg/ml) with 0.1% ropivacaine for 24 h after surgery at a rate of 5 ml/h. The visual analogue scale (VAS) was used to evaluate pain and the incidence of side effects such as nausea/vomiting, pruritis, dizziness, and respiratory depression were recorded at 4, 8, 12, 24 h after surgery. RESULTS:Group HR showed a lower VAS than group FR at 4, 12 and 24 h after surgery, but a higher incidence of nausea and vomiting at 8 h after surgery, and a higher incidence of pruritis at 8 and 12 h after surgery. None of the patients showed respiratory depression. CONCLUSIONS:Lumbar epidural infusion of hydromorphone more effectively controlled acute pain after total knee arthroplasty when compared with fentanyl, but some adverse effects such as nausea and vomiting appeared to occur more frequently.

Comparison of hydromorphone and fentanyl administered by lumbar epidural as patient-controlled analgesia after total knee arthroplasty

BACKGROUND:Hydromorphone is a semi-synthetic opioid that has recently been used for the control of acute and chronic pain.It has been reported that epidural infusion of hydromorphone provides rapid onset of analgesia and a lower incidence of side effects than morphine.However, comparative studies of hydromorphone and lipophilic opioids such as fentanyl are rare.Therefore, we compared the analgesic effects and side effects of hydromorphone infused epidurally with fentanyl in patients who underwent total knee arthroplasty. METHODS:In a randomized, double-blind manner, 79 patients (ASA I-III, aged 60?75) underwent total knee arthroplasty and were provided with patient-controlled epidural analgesia (PCEA) using a lumbar spinal/epidural-combined technique. Group HR (n = 39) received epidurally administered hydromorphone (4microg/ml) with 0.1% ropivacaine, while group FR (n = 40) received epidural fentanyl (2microg/ml) with 0.1% ropivacaine for 24 h after surgery at a rate of 5 ml/h. The visual analogue scale (VAS) was used to evaluate pain and the incidence of side effects such as nausea/vomiting, pruritis, dizziness, and respiratory depression were recorded at 4, 8, 12, 24 h after surgery. RESULTS:Group HR showed a lower VAS than group FR at 4, 12 and 24 h after surgery, but a higher incidence of nausea and vomiting at 8 h after surgery, and a higher incidence of pruritis at 8 and 12 h after surgery. None of the patients showed respiratory depression. CONCLUSIONS:Lumbar epidural infusion of hydromorphone more effectively controlled acute pain after total knee arthroplasty when compared with fentanyl, but some adverse effects such as nausea and vomiting appeared to occur more frequently.

Anaphylaxis after injection of ketorolac in the recovery room: A case report / 대한마취과학회지

Anaphylaxis is an acute onset, potentially fatal systemic allergic reaction. Multiple agents can cause anaphylaxis in the perioperative setting. Ketorolac is a potent analgesic drug and has been widely used for postoperative pain control. A 38-year-old male patient, who had surgery under general anesthesia without any problems, was scheduled for a spinal fusion. There were no problems during anesthesia. In post anesthetic care unit, he was given 30 mg of ketorolac intravenously. After the ketorolac injection, severe hypotension and tachycardia developed and delayed skin rash and wheel appeared. The patient was given epinephrine, antihistamine and steroid. The patient recovered without any significant complications.