The intravenous administration of midazolam is widely used as sedative premedication for upper gastrointestinal endoscopy. We performed a study to evaluate the effectiveness and safety of midazoiam as premedication for upper gastrointestinal endoscopy. Between June 1995 and October 1995, 112 patients of diagnostic esophago-gastroduodenoseopy were enrolled in the study. The patients were recieved a bolus midazolam 0.~03mg/kg or placebo, followed by typical anesthesia. The blood pressure, pulse and oximeter values were monitored. The systolic blood pressure and heart rate were increased during endoscopy in compared with before premedication, and normalized immediately. There was no significant change of arterial oxygen saturation. Midazolam induced amnesia completely in 49.2% and partially in 27.2%, and all patients were recovered completely in 1 hour. The tolerance score is higher in the midazolam group as compared with the placebo group(p<0.05), and midazolam group would accept the same sedation for repeated endoscopies(p<0.01). We conclude that midazolam has beneficial effects as premedication for upper gastrointastinal endoscopy without significant altteration in cardiopulmonary parameters. This suggest that midazolam may be used more frequently as premedication, especially in the cases of repeated endoscopy.
Administration, Intravenous ; Amnesia ; Anesthesia ; Blood Pressure ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal* ; Heart Rate ; Humans ; Midazolam* ; Oxygen ; Premedication*

Human-derived materials are a crucial element of research in the life sciences. The Korea Biobank Network (KBN) portal is a shared open platform that provides the nationʼs most extensive disease resources, possessed by Human Bioresource Unit Banks of the KBN, to the public, including those in the fields of industry, academia, and research.This platform was developed to increase the efficient use of national disease resources. In the KBN portal, the current status of disease resources collected in Korea can be checked online. Human bioresources and clinical information are provided to consumers through systematic search and efficient distribution programs. Additionally, by simultaneously operating the KBN Distribution Support Center, we are working to support the rapid and convenient distribution of human resources in response to the needs of consumers. To effectively utilize the open human bioresource sharing platform, it is necessary to introduce an integrated clinical information management system. Currently, the KBN is in the process of establishing standard terminology for data and applying a common data model for the integrated management of various clinical information held by the KBN. We provide communications through the KBN portal, which is interconnected with the distribution support center, regional biobanks, and consumers. In conclusion, the KBN portal will provide open innovation by creating a business or service model by delivering shared open data and internalizing external innovative capabilities.

We report a rare case of a massive fatal embolism that occurred in the middle of endoscopic retrograde cholangiopancreatography (ERCP) and retrospectively examine the significant causes of the event. The patient was a 50-year old female with an uncertain history of previous abdominal surgery for multiple biliary stones 20 years prior. The patient presented with acute right upper quadrant pain. An abdominal computed tomographic (CT) scan revealed the presence of multiple stones in the common bile duct (CBD) and intra-hepatic duct (IHD) with biliary obstruction, multifocal liver abscesses, and air-biliarygram. Emergency ERCP showed a wide and straight opening of choledochoduodenostomy, which may have been created during a previous surgery, and multiple filling defects in the CBD. With the use of a forward endoscope, mud stones were extracted through the opening of the choledochoduodenostomy. Cardiac arrest suddenly developed during the procedure, and despite immediate resuscitation, the patient died due to a massive systemic air embolism. We reviewed previously reported fatal cases and accessed factors facilitating air embolisms in this case.
Cholangiopancreatography, Endoscopic Retrograde/*methods ; Choledochostomy/*methods ; Common Bile Duct/radiography ; Embolism, Air/*complications ; Fatal Outcome ; Female ; Humans ; Liver Abscess/pathology ; Middle Aged ; Tomography, X-Ray Computed

BACKGROUND: C-reactive protein (CRP) levels are known to reflect chronic inflammatory processes of the cardiovascular system. In particular, it has been reported that high-sensitivity CRP (hs-CRP) may be a promising marker of development of atherosclerosis and cardiovascular disease. CRP may also have an active role in atherogenesis. METHODS: The relationship between hs-CRP and the classic cardiovascular risk factors was assessed in 186 subjects, aged 23-75 years, who entered the health-check program of Chung-Ang University Hospital. hs-CRP was measured by immunoturbidimetric assay. Quintiles of hs-CRP (quintile 1; < 0.7, quintile 2; 0.7-1.1, quintile 3; 1.2-1.9, quintile 4; 2.0-3.8, quintile 5; 3.9-15 mg/L), total cholesterol (TC)/high density lipoprotien-cholesterol (HDL-C) ratio, and relative risk (RR) estimates derived from quintiles of hs-CRP and TC/ HDL-C ratio, were used for the data analysis. RESULTS: Of the 186 subjects, 48 were hypertensive and 138 were normotensive. The serum hs-CPR values for the hypertensive subjects were 0.27+/-0.83 mg/L, compared to 0.12+/-0.23 mg/L for the normotensive subjects; this difference was not significant (P=0.0536) when tested on the arithmetic means, but highly significant (P=0.0091) when the geometric means were compared. The quitiles of hs-CRP were also significantly higher (P=0.0094) in the hypertensive subjects than in the normotensive subjects, when evaluated using Wilcoxon rank sum test. Of the 138 normotensive subjects, only 35 (25.4%) were in quintile 3 or over 3 and 18 (13.0%) in quintile 4 or 5, whereas the respective figures for the 48 hypertensive subjects were 21 (43.8%) and 15 (31.3%). Similarly, of the normotensive subjects, only 47 (34.1%) had RR estimates over 2 and 19 (13.8%) over 3, whereas the respective figures for the hypertentive subjects were 28 (58.3%) and 16 (33.3%). CONCLUSIONS: High-sensivity CRP may be useful in for the screening of the subjects who need preventive measures against cardiovascular diseases. The quintiles of hs-CRP, together with TC/HDL-C ratio, may be useful for the estimation of RR in subjects with low levels of hs-CRP.
Atherosclerosis ; C-Reactive Protein* ; Cardiovascular Diseases ; Cardiovascular System ; Cholesterol ; Humans ; Hypertension ; Mass Screening ; Risk Factors ; Statistics as Topic

Reactive hemophagocytic syndrome or hemophagocytic lymphohistiocytosis, is characterized by the proliferation of benign histiocytes showing phagocytosis of blood cells in hematopoietic organs including bone marrow, spleen, or lymph nodes, accompanied by fever, hepatosplenomegaly, hepatic dysfunction, pancytopenia, and hypertriglyceridemia. The pathogenesis of reactive hemophagocytic syndrome is unknown. It is often associated with infection, malignant neoplasm, autoimmune disease, drugs and various immunodeficiencies. The prognosis of this syndrome is poor and the causes of death are hemorrhage, infection, or multiorgan failure. We experienced a case of hemophagocytic syndrome with terminal ileal ulcers, not associated with other causes. Thus, we report this case with a review of literatures.
Adult ; Fatal Outcome ; Humans ; Ileal Diseases/complications/*diagnosis ; Lymphohistiocytosis, Hemophagocytic/complications/*diagnosis/pathology ; Male ; Tomography, X-Ray Computed ; Ulcer/complications/*diagnosis

Idiopathic hemochromatosis is hereditary hemochromatosis without secondary cause. Hereditary hemochromatosis is a common disorder of iron metabolism with a prevalence of 1 case per 250-300 persons. Affected individuals absorb excessive amounts of dietary iron for a long time and tissue iron deposition results in skin discoloration, arthropathy, hepatic cirrhosis, heart cirrhosis, heart failure, diabetes mellitus and impotence. Early diagnosis and institution of phlebotomy treatment will prevent these manifestations and normalize life expectancy. We report a case of hemochromatosis in 65-year-old male of no transfusion and iron ingestion history who was anti-HCV(+), chronic alcoholic, hepatic iron index>2.24.
Aged ; Alcoholics ; Diabetes Mellitus ; Early Diagnosis ; Eating ; Erectile Dysfunction ; Fibrosis ; Heart ; Heart Failure ; Hemochromatosis* ; Humans ; Iron ; Iron, Dietary ; Life Expectancy ; Liver Cirrhosis ; Male ; Metabolism ; Phlebotomy ; Prevalence ; Skin

BACKGROUND/AIMS: The prevalence of occult HBV infection depends on the prevalence of HBV infection in the general population. Hemodialysis patients are at increased risk for HBV infection. The aim of this study was to determine the prevalence of occult HBV infection in hemodialysis patients. METHODS: Total of 98 patients undergoing hemodialysis in CHA Bundang Medical Center (Seongnam, Korea) were included. Liver function tests and analysis of HBsAg, anti-HBs, anti-HBc and anti-HCV were performed. HBV DNA testing was conducted by using two specific quantitative methods. RESULTS: HBsAg was detected in 4 of 98 patients (4.1%), and they were excluded. Among 94 patients with HBsAg negative and anti-HCV negative, one (1.1%) patient with the TaqMan PCR test and 3 (3.2%) patients with the COBAS Amplicor HBV test were positive for HBV DNA. One patient was positive in both methods. Two patients were positive for both anti-HBs and anti-HBc and one patient was negative for both anti-HBs and anti-HBc. CONCLUSIONS: The present study showed the prevalence of occult HBV infection in HBsAg negative and anti-HCV negative patients on hemodialysis at our center was 3.2%. Because there is possibility of HBV transmission in HBsAg negative patients on hemodialysis, more attention should be given to prevent HBV transmission.
Adult ; Aged ; Aged, 80 and over ; Antibodies/blood ; DNA, Viral/analysis ; Feces/*virology ; Female ; Hepatitis B/complications/*epidemiology/transmission ; Hepatitis B Core Antigens/immunology ; Hepatitis B virus/genetics/immunology ; Hepatitis C Antibodies/blood ; Humans ; Kidney Failure, Chronic/*complications/diagnosis ; Male ; Middle Aged ; Polymerase Chain Reaction ; Prevalence ; Renal Dialysis ; Risk Factors

Acute clinical deterioration in patients with chronic liver disease is called acute on chronic liver failure (ACLF). Principles of management of ACLF consist of early identifying etiology of liver disease, rapid intervention of precipitating event and discreet intensive cares. Despite medical intensive cares, if liver failure progresses, liver transplantation could be the other option. Also, liver transplantation is the only treatment that offers a chance of cure for hepatocellular carcinoma (HCC) and the underlying liver cirrhosis simultaneously. Emergent living donor liver transplantation (LDLT) can be performed for patients with acute liver failure and improves survival rate, especially in circumstances which liver graft is often not available because of deceased donors are not affordable. Here, we describe a chronic hepatitis B patient who developed ACLF accompanying early HCC. Because he did not improved with medical care, he received emergent LDLT. After LDLT, he showed great improvement without critical complications.
Acute-On-Chronic Liver Failure* ; Carcinoma, Hepatocellular* ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Liver Cirrhosis ; Liver Diseases ; Liver Failure ; Liver Failure, Acute ; Liver Transplantation* ; Liver* ; Living Donors* ; Survival Rate ; Tissue Donors ; Transplants

Alfa-interferon(IFN) has become the major therapeutic modality for chronic viral hepatitis. The spectrum of side effects is one of the main drawbacks of this treatment. Alfa-INF is known to lead to neuropsychiatric sym ptoms. Neuropsychiatric toxicity, including cognitive dys function, irritability, personality changes and emotional instability cause interpersonal problems, discontinuation of work and domestic discord. Other more serious IFN- induced signs of neurotoxicity include delirium, depres sion and seizures. The psychiatric side effects fell into three categories: an organic personality syndrome charac terized by irritability, and short temper; an organic affective syndrome marked by extreme emotional lability, depression and tearfulness; and a delirium marked by clouding of consciousness, agitation, paranoia, and suicial potential. These complications are thought to be revers ible with dose reduction or cessation of therapy. There fore it is important that physicians, patients and their families are informed about the potential risk of the emotional and psychiatric disturbances that can occur during alfa-INF therapy. We report three patients who had neuropsychiatric complications during long-term interferon alfa therapy.
Consciousness ; Delirium ; Depression ; Dihydroergotamine ; Hepatitis* ; Humans ; Interferon-alpha* ; Interferons* ; Paranoid Disorders ; Seizures

Complications associated with an intramural hematoma of the bowel, is a relatively unusual condition. Most intramural hematomas resolve spontaneously with conservative treatment and the patient prognosis is good. However, if the symptoms are not resolved or the condition persists, surgical intervention may be necessary. Here we describe internal incision and drainage by endoscopy for the treatment of an intramural hematoma of the duodenum. A 63-yr-old woman was admitted to the hospital with hematemesis. The esophagogastroduodenoscopy (EGD) showed active ulcer bleeding at the distal portion of duodenal bulb. A total of 10 mL of 0.2% epinephrine and 2 mL of fibrin glue were injected locally. The patient developed diffuse abdominal pain and projectile vomiting three days after the endoscopic treatment. An abdominal computed tomography revealed a very large hematoma at the lateral duodenal wall, approximately 10X5 cm in diameter. Follow-up EGD was performed showing complete luminal obstruction at the second portion of the duodenum caused by an intramural hematoma. The patient's condition was not improved with conservative treatment. Therefore, 21 days after admission, endoscopic treatment of the hematoma was attempted. Puncture and incision were performed with an electrical needle knife. Two days after the procedure, the patient was tolerating a soft diet without complaints of abdominal pain or vomiting. The hematoma resolved completely on the follow-up studies.
Drainage ; Duodenal Diseases/*diagnosis/pathology/surgery ; Endoscopy, Digestive System ; Female ; Gastrointestinal Hemorrhage/*etiology/therapy ; Hematoma/*diagnosis/pathology/surgery ; Humans ; Intestinal Obstruction/*etiology/therapy ; Middle Aged ; Tomography, X-Ray Computed