The Trail, 1987-02-12

https://soundideas.pugetsound.edu/thetrail_all/2446/thumbnail.jp

Risk factors associated with changes in oxygenation and pulse rate during colonoscopy

Background/aims: Although hypoxemia is a relatively common complication of colonoscoy, the possible predictive factors of oxygen desaturation and tachycardia in patients undergoing this procedure are not well known. In this study, the possible predictive factors of severe oxygen desaturation (SaO290%) and tachycardia in patients with undergoing colonoscopy were investigated. Methods: A total of 79 consecutive patients were evaluated in the study (46 men and 33 women). Significant oxygen desaturation was considered to be a reduction of arterial oxygen saturation (SaO2) to less than 90%. Tachycardia was defined as a heart rate above 100/min. Patients with inadequate colonoscopy were excluded from the study. The incidence of arterial hemoglobin oxygen desaturation and changes of heart rate during colonoscopy were evaluated and clinical factors in relation to these findings were assessed. Results: The SaO2 during colonoscopy fell below 90% in 19 of the 79 patients (24.1%). The risk factors for desaturation were advanced (>60yr) age (OR: 6.03; 95% CI, 1.35-26.99), receiving sedation (OR: 11.42; 95% CI, 2.05-63.49), chronic lung disease (OR: 4.54; 95% CI and 1.40-11.68), and obesity (OR: 8.95; 95% CI, 1.17-68.55). The presence of hypertension and anemia, a history of cigarette smoking and duration of the colonoscopy had no significant effect on arterial oxygen desaturation (p>0.05). The pulse rate was raised above 100/min during colonoscopy in 26 of 79 patients (32.9%). Increase in heart rate was found to be related to arterial oxygen desaturation (OR: 13.72; 95% CI, 2.67-70.32), anemia (OR:6.17; 95% CI, 1.15-32.91) and advanced (>60 yr) age (OR: 6.08; 95% CI, 1.62-22.81). Gender, sedation, obesity, hypertension, chronic lung disease and smoking did not affect the heart rate (p>0.05). Two patients had transitional bradyarrythmia, which had no relationship with the parameters studied. There was no incidence of significant hypoxia or change in heart rate which might have caused termination of the procedure. Conclusions: Benign and transient arterial oxygen desaturation and tachycardia may occur during colonoscopy procedure. Sedation, obesity, advanced age and chronic lung disease might contribute to these adverse events

Predictive value of proliferating cell nuclear antigen index in response to interferon treatment in patients with chronic viral hepatitis B and C

Background/aims: There are several parameters which may predict the response to interferon therapy in patients with chronic hepatitis B and chronic hepatitis C. The aim of this study was to evaluate the predictive value of proliferating cell nuclear antigen index (PCAN-i) in determining the response rate to interferon therapy in patients with these infections. Methods: Twenty-three patients with chronic hepatitis B and 27 with chronic hepatitis C were included in the study. Prior to therapy, liver biopsies were evaluated with respect to Knodell's index and PCNA-i. Results: Histologic activity indices of the patients with chronic hepatitis B and chronic hepatitis C were similar, but the patients with chronic hepatitis B had higher PCNA-i compared to those with chronic hepatitis C (15.4±5.5 vs 11.3±5.0, p=0.009). PCNA-i was significantly lower in non-responders than responders in the chronic hepatitis B group, whereas responders tended to have lower PCNA-i values in patients with chronic hepatitis C. Conclusions: Responders with chronic hepatitis B had elevated PCNA-i, while the patients with chronic hepatitis C who responded to interferon therapy tended to have lower PCNA-i but the reason for that difference is not clear. According to these results PCNA-i may be used as a predictive marker for the response to interferon therapy in patients with chronic hepatitis B

Risk of bacteremia in emergent endoscopic variceal sclerotherapy

Endoskopik girişim sonrası bakteriyemi insidansı konusunda yapılan çalışmalardan elde edilen sonuçlar tartışmalıdır. Bu prospektif çalışmada acil tanısal endoskopi ve varis skleroterapisi yapılan hastalarda bakteriyemi sıklığını belirlemeyi amaçladık. Yöntem: Tümü yoğun bakım ünitesinde yatan 40'ı varis dışı kanama ve 22 varis kanama tanısı olan toplam 62 üst gastrointestinal sistem kanamalı hasta çalışmaya alındı. Tüm hastalara hastaneye geldikleri ilk 24 saat içinde tanısal endoskopi ve varis skleroterapisi yapıldı. Varis dışı skleroterapi yapılanlar ile son 7 gün içinde antibiotik kullanan hastalar çalışmaya alınmadı. Hastalardan işlemden hemen önce ve 30 dakika sonra kan kültürü alındı. Bulgular: Hiç bir hastada preendoskopik bakteriyemi saptanmazken, tanısal acil endoskopi yapılan olguların 2 (%4.5)'sinde, acil varis skleroterapisi yapılan olguların ise 2 (%9.09) sinde işlem sonrası kültürlerde üreme gözlendi. Bakteriyemi açısından iki grup arasında fark saptanmadı (p>0.05). Sonuç: Sonuçlarımız diagnostik veya terapötik acil endoskopik girişimleri takiben geçici bakteriyemi oluşabileceğini göstermiştir. Acil endoskopik skleroterapiyi takiben gelişen bakteriyemi insidansı diğer endoskopik işlemlerden farklı değildir. Acil endoskopik skleroterapi enfeksiyon açısından güvenilir olup yüksek riskli gruplar dışında antibiotik kullanımı gerektirmemektedir

Disseminated tuberculosis with massive gastrointestinal bleeding after liver transplantation

Tuberculosis is a serious opportunistic infection in transplant recipients. We report the case of a 41 year-old woman with disseminated tuberculosis that caused massive lower gastrointestinal bleeding following orthotopic liver transplantation. The patient presented with fever of unknown origin and without any clinical signs 13 months after orthotopic liver transplantation. Liver biopsy performed for increasing alanine aminotransferase and bilirubin levels showed a granuloma, following which Mycobacterium (M) tuberculosis was determined in sputum. In the first week of antituberculous treatment, massive lower gastrointestinal bleeding occured. Angiography showed extravasation from the proximal and mid jejunum as the source of bleeding. The patient underwent surgery to control the bleeding and segmentel resection of the jejunum was performed. M. tuberculosis was also determined in the histopathologic specimens of jejunum, liver and mesenteric lymph nodes and culture of the specimens. Although bleeding stopped after surgery, the patient died from septicemia and multi-organ failure due to disseminated tuberculosis after three weeks of therapy. This is the first report of disseminated tuberculosis with massive gastrointestinal bleeding after orthotopic liver transplantation