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Introduction: Air embolism as a complication of medical procedure is very rare. The complication has been observed during various types of endoscopic procedures. This case was presented of cerebral air embolism that occurred immediately after EVL. Case report: A 73-year old man developed hematemesis and was brought to our hospital. The medical history included cirrhosis of the liver from alcolism and no episode of variceal bleeding. On arrival, the patient was conscious. His blood pressure was 100/50 mmHg. The results of laboratory test were WBC 9,790/μ L, Hgb 6.9 g/dL, platlet count 101×103/μL, total protain 3.8 g/dL, albumin 2.2 g/dL, total bilirubin 0.95 mg/dL, prothrombin time 52%. Emergency endoscopy was performed and spurting bleeding was observed at esophagogastric junction. After insertion of a flexible overtube, the endoscope was removed and the reinserted with an EVL device attached to the tip. Ligation was successfully performed after suction of esophageal mucosa. Immediately after ligation, The patient was became unconscious & had convulsion. CT image of brain (Fig. 1) revealed intracranial air that was distributed in the area supplied by the right middle cerebral artery. The patient discharged one month later and remained left hemiparesis weekly. Conclusion: There is always the risk that a stroke or another unexpected complication may occur in patients undergoing EVL. When symptoms referable to the central nervous system developed in these situations, air embolism, although rare, should be considered.
Background: The asthma mortality has risen during last decades, especially in the elderly. This study was performed to investigate whether newly-developed asthma in the elderly has any difference in clinical features relating to asthma severity compared to early-onset asthma (EOA).Methods: Thirty-three asthma patients (≥60 years-old) hospitalized due to severe attack were classified to late-onset (LOA) when their asthma developed after the age of 60 and the remaining to EOA. Data obtained from their medical records were analyzed retrospectively. Results: Ten out of the 33 patients (30.3%) were LOA. Duration of asthma was significantly longer in EOA (21.6±14.8 years vs. 2.9±2.4 years, p$lt;0.001). There were no significant differences between both groups in age, sex, atopy history (personal and familial), sinusitis, and peripheral blood eosinophils. However, EOA showed more smoking history and frequent exacerbations following URI-like symptoms (p$lt;0.05, respectively), and higher serum total IgE level (geographiean: 228 vs. 20 IU/mL, p$lt;0.001). Life-threatening asthma attack was developed more frequently (89.5% vs. 40%, p$lt;0.05), and the lung function measurements obtained just before discharge were significantly lower (FEV1/FVC: 54.8±10.1% vs. 64.6±11.7%, p$lt;0.05) in EOA. Severity of chronic asthma was significantly more severe in EOA (moderate to severe persistent asthma: 95.6% vs. 60.0%, p$lt;0.05). Conclusion: Many elderly asthmatics develop asthma newly in their old age. EOA is more related to atopic allergy, and seems to have more severe and long-standing asthma leading to chronic persistent airflow obstruction.(Korean J Med 61:616-622, 2001)
Background: It has been shown that severe asthmatic attacks are related to airway hyperresponsiveness(AHR). However, there has been no study on AHR measured just after control of acute severe asthma. Objective : To determine the degree of AHR following acute severe asthma and to evaluate the safety of AHR measurement in patients just recovering from a severe attack. Method: In 23 consecutive asthma patients just recovering from a severe attack (10 severe, 13 near-fatal). All medications except inhaled or systemic steroids were withdrawn temporarily for more than each action time. Then a methacholine bronchoprovocation test was performed in patients with FEV1≥75% of predicted or personal best value. Results : Mean duration required to control asthma was 5.6±3.6 days, and methacholine provocation test was performed at 12.6+5.2 hospital days. The patients showed significantly lower methacholine-PC20(geometric mean 0.54 vs 1.64 mg/ml, p$lt;0.05) and steeper slope of dose-response curve(p$lt;0.01) compared to 62 outpaents. Initial FEV₁5(r=0.470. p$lt;0.05) and the duration required to control asthma(r =-0.623. p$lt;0.01) were significantly related to methacholine-PC20. However, only 9 patients(39.1%) showed severe AHR. which was not significantly different from outpatients(25.8%). Conclusion : These results suggest that AHR is a risk factor of severe asthmatic attack and methacholine challenge just after control of acute asthma is relatively safe.