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 Adenocarcinoma in Ileocecal Valve Mimicking Inflammatory Bowel Disease / 대한소화기내시경학회지

Adenocarcinoma of the ileocecal valve is rare. It's clinical manifestations are non-specific such as intestinal intussusception, obstruction and right lower abdominal discomfort according to type of cancer. Particularly infiltrative type carcinoma of the ileocecal valve may be easily misdiagnosed as inflammatory bowel disease by radiological imagings and clinical symptoms. We experienced one case of adenocarcinoma of the ileocecal valve mimiking inflammatory bowel disease in radiological features. Colonoscopic findings also could not differentiate malignancy with chronic inflammatory condition. We report a case of adenocarcinoma of the ileocecal valve, which endoscopic findings mimic chronic inflammatory disease, with a review of literature.

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.

A case of acute pyelonephritis complicated with renal vein thrombosis / 대한내과학회지

A 57-year-old woman who had a history of diabetes was admitted due to fever and left flank pain. Acute pyelonephritis was diagnosed by clinical findings including left costovertebral area tenderness, positive urine and blood cultures. Subsequent abdominal computed tomography demonstrated multiple abscess pockets in the left renal parenchyme and ipsilateral renal vein thrombosis. She was fully recovered after treatment with antibiotics, low-molecular weight heparin and low-dose aspirin for six weeks. Our case emphasizes that renal vein thrombosis could be complicated in acute pyelonephritis, especially in patients with diabetes. It is reasonable to speculate that factors such as hemoconcentration caused by fever and osmotic diuresis and compression of renal vascular pedicle by renal abscess might have had a role in inciting the renal vein thrombosis.