A comparative study on initial pleural fluid findings of tuberculous pleurisy between patients with and those without pleural thickening / 대한내과학회지

BACKGROUND: Indicator that can predict pleural thickening in pleural tuberculosis has not been known clearly. By the previous study, patients with pleural thickening > or =10 mm had significantly lower glucose and pH values and higher lysozyme and TNF-alpha values than those with pleural thickening or =10 mm and 12 patient (54.5%) had pleural thickening > or =3 mm. Initial pleural fluid protein, LDH, pH, glucose and IFN-gamma, Interleukin-1alpha (IL-1alpha) were studied. RESULTS: Pleural fluid levels of protein, LDH, glucose, and IFN-gamma were not statistically significant different not only between the group of pleural thickening > or =3 mm and the group of pleural thickening or =10 mm and the group of pleural thickening or =3 mm (85.9+/- 37.1 U/mL) was significantly higher than without thickening (44.8+/-32.0 U/mL) (p or =10 mm (106.9+/-8.6 U/mL) was significantly higher than without thickening (58.5+/-8.6 U/mL)(p< 0.001). CONCLUSION: Although patient number of our study was smaller than the previous study, IFN-gamma level in initial pleural fluid of pleural tuberculosis may be considered as the predictive factor of pleural thickening.

The Effect of Propofol for Sedation during Upper Gastrointestinal Endoscopy / 대한소화기내시경학회지

BACKGROUND AND AIMS: This research was conducted in order to study the clinical usefulness and stability of the propofol used for sedation during upper gastrointestinal endoscopy. METHODS: The objective of this research was to study one hundred patients, who were chosen based upon their preference to be examined through diagnostic upper gastrointestinal endoscopy accompanied with propofol from July 1998 to August 1998, and who showed normality in the pulmonary function test and ECG. The elements observed were hemodynamic variations, injection dosage, injection time, recovery time and side effects. RESULTS: All patatints had no recollection of the procedure during gastrointestinal endoscopy. It was found that the older the patients were, the less amount of propofol sleep was indued. Systolic blood pressure, diastolic blood pressure and the mean arterial blood pressure were lowered noticeably after sleep, compared with those before the injection of propofol, while the heart rate hardly changed. CONCLUSIONS: Profopol is believed to be a useful sedative for upper gastrointestinal endoscopy. As blood pressre can be lowered however, a cautious attitude should be considered when injecting propofol in the elderly or in patients who have cardiovascular disease.

A Case of a Gastric Bezoar Regurgitated from the Stomach to the Esophagus / 대한소화기내시경학회지

Bezoars are persistent concretions of indigestible material, usually seen in the stomach. Esophageal bezoars are very rare and generally occur in elderly patients with anatomic defects such as diverticulum or stricture, or with esophageal motility disorders. However, it is quite unusual that a gastric bezoar would be regurgitated into a normal esophagus during forceful vomiting. Endoscopic removal of a bezoar is safe and successful in most cases. A case of a gastric bezoar regurgitated into the esophagus was recently experienced and removed by an endoscopic polypectomy snare and bezoar (lithotripsy) basket.

A case of esophageal bezoar consisted with candidiasis / 대한내과학회지

Bezoars are persistent concretions of indigestible matter, usually seen in the stomach. But very rarely have bezoars been reported in the esophagus.. Most esophageal bezoars are either phytobezoars or medication bezoars occuring usually in the middle aged & elderly associated with underlying anatomical or functional abnormalities of esophagus. A variety of techniques has been developed recently in diagnostic and therapeutic endoscopy. So endoscopic management is safe and successful in most cases those required surgical management. We experienced an esophageal bezoar consisted with esophageal candidiasis in a patient who underwent esophago-gastric anastomosis and proximal gastrectomy due to early gastric cancer. The bezoar was removed by endoscopy and the esophago-gastric stenosis was treated with balloon dilator without any significant complication.

2 Cases of Endoscopic Ligation Therapy of a Dieulafoy Ulcer / 대한소화기내시경학회지

A dieulafoy ulcer is rarely recognized but is not an uncommon cause of massive, recurrent and frequently fatal gastrointestinal bleeding resulting from the erosion of an unusually large submucosal artery. Although the lesion has been predominantly found in the proximal stomach, it has also been detected throughout the gastrointestinal tract. Diagnosis can be made by observation of protruding and eroded arteries with pulsatile bleeding, or through detection of an adherent thrombus using an endoscopy. In the past, surgical intervention was believed to be the best treatment, but currently, therapeutic endoscopy is more favored, due to its recent success in achieving permanent hemostasis. We experienced 2 cases of Dieulafoy's ulcer of the stomach. Endoscopic ligations using an O ring were performed successfully.

Observation of 35 Cases of Mallory: Weiss Syndrome Diagnosed by Endoscopy / 대한소화기내시경학회지

35 cases of Mallory-Weiss syndrome among 277 cases of upper gastrointestinal bleeding were ascertained by endoscopy at department of internal medicine St. Columban's hospital. The mean age was 41.6 years. All of 35 cases were found in male. Combined disease were gastritis(15 cases), peptic ulcer(7 cases) and esophageal varix(3 cases). The most common precipitating factor was vomiting, 22 cases among the 28 cases of vomiting(80%) developed after drinking. Endoscopic finding revealed active bleeding in 5 cases, blood clot without active bleeding in 22 cases, and scar change without bleeding evidence in 8 cases. Most cases had had hematemesis after active bleeding but 5 cases had had only melena without hematemesis. The Mallory-Weiss lacerations were located at stomach in 16 cases(46%), at esophagogastric junction in 11 cases(31%) and at esophagus in 8 cases. On the view of gastric direction, 14 cases were on anterior wall side, 9 cases were on posterior wall side, 11 cases were on lesser curvature side and one case was on great curvature side. Single lacerations were more common than multiple lacerations.