Han Hyo Lee

Giant Hyperplasia of the Caudate Lobe in a Patient with Liver Cirrhosis: Case Report and Literature Review

The caudate lobe often exhibits enlargement and nodularity in cases of cirrhosis, which makes differentiation of hepatocellular carcinoma from other mass-like lesions of the caudate lobe difficult in cirrhotic patients. A 12x6 cm mass-like enlargement of the caudate lobe was incidentally found by computed tomography in a 38-year-old man suffering from alcoholic liver cirrhosis. Magnetic resonance imaging, liver colloidal scan, and sonoguided liver biopsy were used for the differential diagnosis. A literature review revealed two case reports, all of which (like ours) presented with an enlarged caudate lobe supplied with blood via a branch of the portal vein. Therefore, in cases of giant hyperplasia of the caudate lobe, confirmation of the caudate lobe blood supply and the enhancement pattern might be important for the differentiation.

Effect of Chronic Alcohol Consumption on Conscious Sedation During Colonoscopy Using Midazolam

How Safe Is Upper GI Endoscopy? David Mclernon, John Dillon, Anne Crozier, Peter Donnan, Craig Mowat With the move towards non-invasive investigation of dyspepsia, the demographics of those patients proceeding to upper GI endoscopy (OGD) have changed. The safety of OGD remains important. The National Confidential Enquiry into Perioperative Deaths recently reported on the morbidity and mortality of therapeutic procedures in England and Wales. Data collection was incomplete. The previous national audit of OGD outcomes related to practice in 1995. Aims: to assess the safety of OGD in the current era. Methods: Endoscopy records identified all patients who had OGD from 1 July 2000-30 June 2003. Patients were recordlinked to hospital records (SMR01), Carstairs deprivation scores and the death registry. Deaths within 30 days of OGD were identified and casenotes reviewed. Results: 12,925 OGDs were performed on 10,030 patients; median age 62(IQ range: 48-75), 54% female. 396 deaths occurred within 30 days of the OGD; median age 76 (IQ range: 64–83), giving a crude death rate of 3.95%. For in-patients, this rose to 9.5%, versus 0.86% for outpatients. 128 deaths followed a therapeutic OGD, giving a death rate of 1 in 5 (128/640). 48 of these had a PEG insertion, giving a death rate of 1in 6 for this indication (48/302). The death rate for diagnostic OGD was approximately 1 in 35 (268/9390). Analysis is ongoing but thus far, OGD has been judged as contributary in 43 deaths, giving a crude death rate of approximately 1 in 250. 17 of these patients had a PEG insertion, giving a death rate of 1in 18 (17/302). 22 of the OGD-related deaths followed a therapeutic procedure, giving a death rate of approximately 1 in 29 (22/640). The corresponding rate for diagnostic OGD was approximately 1 in 470 (20/9390). Logistic regression analysis was performed on the outcome of all cause mortality within 30 days of OGD, adjusting for age, sex, deprivation, co-morbidity, in/outpatient, indications, premedication type, diagnosis etc. The odds of an inpatient dying within 30 days of endoscopy compared to an outpatient is 2.29 (p ! 0.001). The odds of dying from a therapeutic procedure compared to a diagnostic procedure is 2.99 (p ! 0.001). Further results will be obtained for endoscopy-related deaths. Conclusions: The safety of OGD is determined by the pre-morbid state of the patient. This suggests that we should be more selective in our use of endoscopy, particularly when there is little likelihood of therapeutic benefit.