ABSTRACT
In a prospective, double-blind, placebo-controlled, parallel-group, clinical study of 129 consecutive patients examined by one experienced endoscopist, we compared two premedication schedules: midazolam plus placebo and midazolam plus ketamine. 40% of the patients receiving midazolam alone needed a second injection, and 15% had to be excluded for failure. In the ketamine-group, 27% received a second injection; there were no treatment failures. The combination of both drugs proved to be safe without added risk. The combination provides more reliable sedation and analgesia and is judged as superior by the endoscopist, and patient's acceptance for re-endoscopy is higher.
Subject(s)
Colonoscopy , Ketamine/administration & dosage , Midazolam/administration & dosage , Premedication , Adolescent , Adult , Aged , Double-Blind Method , Drug Therapy, Combination , Female , Humans , Male , Middle AgedABSTRACT
Liver cysts seldom become symptomatic. For the few requiring intervention, various surgical modalities have been described. Cyst fluid has been removed by simple needle aspiration. Injection of formalin into echinococcus cysts at time of operation is not uncommon. In an analogy to the treatment of kidney cysts, we evacuated a large symptomatic liver cyst by percutaneous drainage and instilled alcohol as a sclerosing agent. This simple procedure may be sufficient treatment for selected symptomatic nonparasitic liver cysts.
Subject(s)
Cysts/therapy , Ethanol/therapeutic use , Liver Diseases/therapy , Sclerosing Solutions/therapeutic use , Combined Modality Therapy , Cysts/congenital , Cysts/diagnosis , Drainage , Female , Humans , Liver Diseases/congenital , Liver Diseases/diagnosis , Middle Aged , Tomography, X-Ray Computed , UltrasonographyABSTRACT
A patient diagnosed in 1963 as having congenital dilation of intrahepatic bile ducts, presented in 1982 with common bile duct lithiasis. Endoscopic papillotomy and stone extraction were followed by an unusual complication, hiccups lasting one week. We suggest that endoscopic papillotomy should be considered in selected patients with Caroli's disease. Typical and atypical features of this case presentation are discussed.
Subject(s)
Bile Duct Diseases/complications , Bile Ducts, Intrahepatic/pathology , Endoscopy , Gallstones/surgery , Adult , Bile Duct Diseases/congenital , Cholangiopancreatography, Endoscopic Retrograde , Common Bile Duct/diagnostic imaging , Common Bile Duct/surgery , Dilatation, Pathologic/congenital , Gallstones/complications , Gallstones/diagnostic imaging , Humans , MaleABSTRACT
Although cirrhosis of the liver caused by alpha 1-antitrypsin deficiency is not uncommon in children, only a few cases have been described in adults. We have seen three such patients--one man and two women, ranging in age from 57 to 66 years. These cases show the wide spectrum of this genetically influenced disease.
