Endoscopic polypectomy was firstly introduced by Tsuneoka in 1969, and till now this method has been widely used for the treatment of benign and malignant polyps with the advent of technical improvement. This method is a very important modality as secondary prevention of malignancy because polyps in gastraintestinal tract are now being considered as precancerous lesion. Polypectomy with snare and electrocautery is mainly used for pedunclated polyps (eg. Yamada Class III, IV), but sessile polyps pose technical difficulty and occasionally cause serious gastrointestinal hemorrhage when resection margin adjacent polyp base. We performed polypectomy with "O"-ring used in endocopic variceal ligation (EVL) to make sessile polyp as semipedunclated form, and also to control bleeding, and then successfully remove it with conventional snare polypectomy. We report these 5 cases with the review of the literature.
Electrocoagulation ; Gastrointestinal Hemorrhage ; Hemorrhage ; Ligation* ; Polyps ; Secondary Prevention ; SNARE Proteins

Paradoxical embolism is a kind of stroke caused by embolism of thrombus of venous origin through a lateral opening in the heart, such as a patent foramen ovale (PFO). Although the most frequent manifestation of paradoxical embolism is cryptogenic stroke, noncerebral paradoxical embolism is also associated with PFO. We experienced a case of cryptogenic renal infarction in a previously healthy 70-year-old man. He had no cardiac thrombus on transthoracic echocardiography and electrocardiogram revealed a normal sinus rhythm. Because it was cryptogenic renal infarction, we performed transesophageal echocardiography with microbubble test. Microbubble test using agitated saline proved the presence of right-to-left shunt and patent foramen ovale was diagnosed. We also performed lower leg doppler ultrasonogram, but there was no evidence of deep vein thrombosis. Although only the presence of a right-to-left shunt is not enough to establish the diagnosis of paradoxical embolism, it is uncommon for the source of the embolism to be identified. In this case, we concluded that paradoxical embolism is the cause of renal embolism. We report paradoxical renal embolism through PFO with review of relevant literatures.
Aged ; Dihydroergotamine ; Echocardiography ; Echocardiography, Transesophageal ; Electrocardiography ; Embolism ; Embolism, Paradoxical ; Foramen Ovale, Patent ; Heart ; Humans ; Infarction ; Kidney ; Leg ; Microbubbles ; Stroke ; Thrombosis ; Venous Thrombosis

PURPOSE: This study was designed to determine the utility of bispectral index scores (BIS) compared to Glasgow coma scale (GCS) or Observer's Assessment of Alertness/Sedation Scale (OAA/S), in measuring changes in consciousness, prognosis and management of sedative-intoxication patients. METHODS: Sedative intoxication patients, who came to the emergency department with a severe deficit in consciousness, or a GCS less than 12, were analyzed. Patients' consciousness states were evaluated using OAA/S and GCS and compared with BIS scores. Patients' consciousness recovery time and hospitalization were recorded to see if these could be predicted by BIS using regression analysis. BIS, OAS/S and GCS were compared with regard to intubation, admission and ICU admission. Furthermore, usefulness and cut-off values of BIS were evaluated for those intubated. RESULTS: Of 128 sedative intoxication patients, 32 were enrolled for this study. Mean age was 50.94+/-18.01. They took 20.76+/-16.95 times over the average recommended dose. OAA/S and GCS ranged between 1~4 and 4~12, respectively; BIS was 39~88. The Spearman bivariate correlation coefficient was 0.619 between OAA/S and BIS and 0.651 between GCS and BIS, both showing a positive correlation (p<0.001). The coefficient of determination between BIS and recovery time was 0.182 and was statistically significant (Recovery time = -0.321xBIS+34.806) (p=0.015). However, admission, ICU admission and hospitalization were not significant (p>0.05). BIS was an effective index for intubation (p=0.012) showing a sensitivity of 91% and a specificity of 50% when the boundary value was set to 65.5. When set to 77.5, sensitivity and specificity were 59%, 100%, respectively. CONCLUSION: In sedative intoxication patients, BIS is useful in determining the degree of sedation, predicting time to recovery of consciousness and as an objective index of intubation.
Consciousness ; Consciousness Monitors ; Emergencies ; Glasgow Coma Scale ; Hospitalization ; Humans ; Hypnotics and Sedatives ; Intubation ; Porphyrins ; Prognosis ; Sensitivity and Specificity

Endobronchial lipomas are rare lesions that usually obstruct a major bronchus and cause irreversible pulmonary damage distally. Herein, a case of an endobronchial lipoma combined with broncholithiasis, found 3 months after first noticing symptoms including dry cough, and voice change, successfully removed by surgical resection is reported
Bronchi ; Cough ; Lipoma* ; Voice