Hematemesis is a rare condition in infants and can be a symptom of cow's milk-induced hemorrhagic gastritis. Other clinical manifestations of cow's milk allergy are vomiting, malnutrition and anemia. The criteria for the diagnosis of cow's milk allergy includes elimination of cow milk formula resulting in improvement of symptoms, specific endoscopic and histologic findings as well as exclusion of other causes. Cow's milk allergy should be considered in the etiologic differential diagnosis of hematemesis and gastritis in infancy. We have experienced a 1-month-old female infant with hematemesis due to cow's milk-induced hemorrhagic gastritis, and report the case with a review of previously published cases.
Anemia ; Diagnosis ; Diagnosis, Differential ; Female ; Gastritis* ; Hematemesis ; Humans ; Infant ; Infant, Newborn ; Malnutrition ; Milk Hypersensitivity* ; Milk* ; Vomiting

BACKGROUND/AIMS: Midazolam is widely used as a form of conscious sedation during endoscopy because of its rapid onset and safety. However, its relatively long half-life and paradoxical reactions are still a concern for doctors and patients. Flumazenil is a competitive benzodiazepine antagonist that acts to reverse the sedative and hypnotic effects of midazolam but its role and adequate dose have not been fully documented. This study evaluated the effect of a fixed dose of flumazenil on the recovery from sedative endoscopy by midazolam. METHODS: First study: 100 patients who received 0.05 mg/kg midazolam for conscious sedation were randomized into two groups: intravenous 0.25 mg flumazenil and a placebo. All patients were assessed using OAA/S (Observers Assessment of Alertness/Sedation Scale) scale (responsiveness, speech, facial expression and ptosis of eyelid) before the endoscopy, immediately after the procedure and every 5 minutes thereafter. The recovery time was defined as the time at which the OAA/S scale reached the pre-endoscopy level. Second study: In 40 patients, the OAA/S scale was assessed only after full recovery without any exogenous stimuli. The total dose of midazolam and the procedure time were assessed. RESULTS: The flumazenil group demonstrated a significantly shorter recovery time than the placebo group (p<0.0001). These results were not affected by age, gender, total midazolam dose and procedure time. There was a larger difference in the recovery time between the two groups in the second study than in the first. CONCLUSIONS: A fixed low dose flumazenil significantly reduced the recovery time after sedative endoscopy by midazolam. Flumazenil will be helpful for the early return to daily activities and for preventing post sedative complication.
Benzodiazepines ; Conscious Sedation ; Endoscopy* ; Facial Expression ; Flumazenil* ; Half-Life ; Humans ; Hypnotics and Sedatives ; Midazolam*

BACKGROUND/AIMS: Midazolam is widely used as a form of conscious sedation during endoscopy because of its rapid onset and safety. However, its relatively long half-life and paradoxical reactions are still a concern for doctors and patients. Flumazenil is a competitive benzodiazepine antagonist that acts to reverse the sedative and hypnotic effects of midazolam but its role and adequate dose have not been fully documented. This study evaluated the effect of a fixed dose of flumazenil on the recovery from sedative endoscopy by midazolam. METHODS: First study: 100 patients who received 0.05 mg/kg midazolam for conscious sedation were randomized into two groups: intravenous 0.25 mg flumazenil and a placebo. All patients were assessed using OAA/S (Observers Assessment of Alertness/Sedation Scale) scale (responsiveness, speech, facial expression and ptosis of eyelid) before the endoscopy, immediately after the procedure and every 5 minutes thereafter. The recovery time was defined as the time at which the OAA/S scale reached the pre-endoscopy level. Second study: In 40 patients, the OAA/S scale was assessed only after full recovery without any exogenous stimuli. The total dose of midazolam and the procedure time were assessed. RESULTS: The flumazenil group demonstrated a significantly shorter recovery time than the placebo group (p<0.0001). These results were not affected by age, gender, total midazolam dose and procedure time. There was a larger difference in the recovery time between the two groups in the second study than in the first. CONCLUSIONS: A fixed low dose flumazenil significantly reduced the recovery time after sedative endoscopy by midazolam. Flumazenil will be helpful for the early return to daily activities and for preventing post sedative complication.
Benzodiazepines ; Conscious Sedation ; Endoscopy* ; Facial Expression ; Flumazenil* ; Half-Life ; Humans ; Hypnotics and Sedatives ; Midazolam*

We report a 40-year-old female patient with clinical findings suggestive of insulinoma. Although imaging studies did not reveal any tumors in the pancreas, a selective arterial calcium stimulation test(SACI), procedurally simpler and more effective than transhepatic pancreatic venous sampling, was performed. And then near total pancreatectomy was carried out because the possibility of small insulinoma could not be completely excluded. Grossly, the surgically removed pancreas did not reveal any tumors. However, the pancreas exhibited islets cell hyperplasia. To our knowledge, this is the first reported authentic case in a Korean adult of islet-cell hyperplasia diagnosed by selective arterial calcium stimulation test.
Adult ; Calcium* ; Female ; Humans ; Hyperplasia* ; Insulinoma ; Pancreas ; Pancreatectomy

Henoch-Schonlein purpura is a systemic leukocytoclastic vasculitis involving small vessels. The diagnostic criteria is defined as a typical skin rash of which pathologic examination shows leukocytoclastic vasculitis, accompanied by any two of these major manifestations of the disease, namely gastrointestinal tract, kidney, joint involvement. In elder patient, Henoch-Schonlein purpura shows more serious gastrointestinal tract involvement. There are some reports of brain involvement of Henoch-Schonlein purpura. A 69-year-old man was admitted to department of neurosurgery, because of loss of consciousness. Brain CT showed acute cerebellar hemorrhage with rapid resolution by conservative treatment. Diffuse purpuric eruptions on both low legs were developed after 7 days of hospitalization. He was refered to our department due to epigastric pain and bloody diarrhea. There were multiple longitudinal ulcers with hemorrhage on the stomach and the sigmoid colon of which biopsy showed leukocytoclastic vasculitis. Microscopic hematuria and proteinuria were also noted. He had a fatal course due to recurrent colonic bleeding and poor medical condition. We report an unusual case of cerebellar and gastrointestinal involvement of Henoch-Schonlein purpura in elderly patient.
Aged ; Biopsy ; Brain ; Colon ; Colon, Sigmoid ; Diarrhea ; Exanthema ; Gastrointestinal Tract ; Hematuria ; Hemorrhage* ; Hospitalization ; Humans ; Joints ; Kidney ; Leg ; Neurosurgery ; Proteinuria ; Purpura, Schoenlein-Henoch* ; Stomach ; Ulcer ; Unconsciousness ; Vasculitis

BACKGROUND: This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules (18microgram once daily) with a ipratropium metered dose inhaler (2 puffs of 20microgram q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). METHOD: After the initial screening assessment and a two-week run-in period, patients received either tiotropium 18microgram once daily or ipratropium 40microgram four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. RESULT: In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted FEV1 of 42 (12)% were analyzed. The trough FEV1 response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. CONCLUSION: This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.
Adult* ; Albuterol ; Bronchodilator Agents ; Capsules ; Forced Expiratory Volume ; Humans ; Inhalation ; Ipratropium* ; Lung ; Mass Screening ; Metered Dose Inhalers ; Outcome Assessment (Health Care) ; Peak Expiratory Flow Rate ; Pulmonary Disease, Chronic Obstructive* ; Surveys and Questionnaires ; Vital Capacity ; Tiotropium Bromide