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Obstructing fungal cholangitis complicating metal biliary stent placement in pancreatic cancer

World Journal of Gastroenterology 2010年第24期16卷 3083-3086页

作者： Brian Story michael gluck Department of Gastroenterology Virginia Mason Medical Center

Biliary obstructions can lead to infections of the biliary system, particularly in patients with occluded biliary stents. Fungal organisms are frequently found in bili-ary aspirates of patients who have been on antibiotics and have stents; however, fungal masses, or "balls", that fully obstruct the biliary system are uncommon and exceedingly diff icult to eradicate. We present 4 cases of obstructing fungal cholangitis in patients who had metal biliary stents placed for pancreatic malignancies, and subsequently required aggressive antifungal administration along with endoscopic and radiologic interventions. This report also reviews approaches previously undertaken to manage severe obstructing fungal cholangitis.

关键词： Obstructing fungal cholangitis Biliary stents Fungal balls Pancreatic cancer Biliary obstruction

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One year experience with computer-assisted propofol sedation for colonoscopy

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World Journal of Gastroenterology 2017年第16期23卷 2964-2971页

作者： Otto S Lin Danielle La Selva Richard A Kozarek Deborah Tombs Wade Weigel Ryan Beecher Johannes Koch Susan Mc Cormick michael Chiorean Fred Drennan michael gluck Nanda Venu michael Larsen Andrew Ross Digestive Disease Institute Virginia Mason Medical CenterSeattleWA 98101United States Department of Anesthesia Virginia Mason Medical CenterSeattleWA 98101United States

AIM To report our one-year experience with computer assisted propofol sedation(CAPS) for colonoscopy as the first United States Medical Center to adopt CAPS technology for routine clinical *** Between September 2014 and August 2015, 2677 patients underwent elective outpatient colonoscopy with CAPS at our center. All colonoscopies were performed by 1 of 17 gastroenterologists certified in the use of the CAPS system, with the assistance of a specially trained nurse. Procedural success rates, polyp detection rates, procedure times and recovery times were recorded and compared against corresponding historical measuresfrom 2286 colonoscopies done with midazolam and fentanyl from September 2013 to August 2014. Adverse events in the CAPS group were *** The mean age of the CAPS cohort was 59.9 years(48.7% male); 31.3% were ASA?Ⅰ, 67.3% ASA Ⅱ and 1.4% ASA Ⅲ. 45.1% of the colonoscopies were for screening, 31.5% for surveillance, and 23.4% for symptoms. The mean propofol dose administered was 250.7 mg(range 16-1470 mg), with a mean fentanyl dose of 34.1 mcg(0-100 mcg). The colonoscopy completion and polyp detection rates were similar to that of historical measures. Recovery times were markedly shorter(31 min vs 45.6 min, P < 0.001). In CAPS patients, there were 20(0.7%) cases of mild desaturation(< 90%) treated with a chin lift and reduction or temporary discontinuation of the propofol infusion, 21(0.8%) cases of asymptomatic hypotension(< 90 systolic blood pressure) treated with a reduction in the propofol rate, 4(0.1%) cases of marked agitation or discomfort due to undersedation, and 2 cases of pronounced transient desaturation requiring brief(< 1 min) mask ventilation. There were no sedation-related serious adverse events such as emergent intubation, unanticipated hospitalization or permanent injury. CONCLUSION CAPS appears to be a safe, effective and efficient means of providing moderate sedation for colonoscopy in relatively healthy patients. Recovery

关键词： Colonoscopy Propofol Sedation Colon cancer screening Anesthesia

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