Effects of Chronic Alcohol Consumption on Midazolam Induced Sedation during Colonoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: It is suggested that patients consuming large amounts of alcohol are difficult to be sedated by midazolam probably due to cross tolerance. We studied to know the adequate administration doses of midazolam in patients with chronic alcohol consumption. METHODS: Study I; We prospectively studied 117 outpatients presenting for colonoscopy. According to alcohol consumption we divided four groups such as group I: 0 g/day, group II: 40 g/day. We initially administered 0.06 mg/kg midazolam and add up to spontaneous eye closure. We measured grade of amnesia, level of consciousness, endoscopist's assessment and VAS scale for pain after recovery. Study II; We measured induction time after 0.08 mg/kg midazolam in 60 patients who drink alcohol. RESULTS: Additional amount of midazolam was not significantly different between the groups (group I: 0.0145 mg/ kg, group II: 0.0214 mg/kg, group III: 0.0181 mg/kg, group IV: 0.0199 mg/kg). There were no differences of sedation parameters between the groups. However the induction time was prolonged and correlated with alcohol consumption. CONCLUSIONS: For adequate sedation in patients with chronic alcohol consumption, longer induction time rather than increasing dosage is required.

A Case of Huge Polypoid Early Gastric Cancer / 대한소화기내시경학회지

The survival rate of gastric cancer is mainly affected by lymph node metastasis and depth of invasion. It is now recognized that in early gastric cancer submucosal invasion and lymph node metastasis depend on the size of tumor. A 71-year-old man with epigastric discomfort for 1 month was admitted. Endoscopy showed a huge polypoid tumor with friable and nodular surface occupying the whole lumen of stomach. We suspected a Borrmann type 1 advanced gastric cancer, but we confirmed the gastric cancer confined to only mucosa without lymph node metastasis after operation. So we report a case of huge polypoid early gastric cancer mimicking advanced gastric cancer with a review of relevant literatures.

Analysis of Elderly Patients who visited Emergency Room

BACKGROUND: Recently elderly people have increased in Korea and increased demands of medical service. To solve the problem of emergency medical service in elderly patients, it is very important to analyze the emergency patients who visit medical service and to accumulate date bases of various hospitals. So the purpose of this study is to evaluate the use of emergency services by the elderly to provide better understanding of the emergency care needs of this specialized populations and provide a basis planning to meet the needs of the expanding geriatric population. METHODS: We performed a retrospective study of 2380 elderly patients who visited Emergency room of national medical center, from August 1, 1999 to July 31, 2000. We analyzed the patients gender, age, arrival time, final diagnosis, admission rate, mortality, ects. RESULT: Male to female ratio is 1:1.29, and most common age group was between 65 and 69 years old. The peak time of patients entrance was between 10 AM and 11AM, in a week monday was most crowding day. The most predomint monthly distribution of visit was January. The respiratory disease are most common problem (14.7%), and cardivascular disease (12.01%) are next, and cerebrovascular disease (11.17%) are following. Diabetic complication (7.53%) are common problems and hypoglycemia and diabetic foot infection are frequent. Admission rates was 32.53%. ICU admission rate is 2.77%. Emergency operation rate is 5.91%. During admission, mortality case was 127 patients. The cause of death were cerebrovascular disease (16.94%) and advanced respiratory disease (15.43%). CONCLUSION: The results show that cerebrovascular disease and respiratory disease and cardiovascular disease that needed prompt medical service are major problem who visit emergency room. And diabetic complications that are prevented by proper educations are common. So more concentrated medical service and preventive effort focused on these disease.