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Background: In France, general anesthesia is given to more than 90% of patients undergoing colonoscopy although in several countries sedation is limited to intolerant patients. This study was carried out to determine whether Patient-Controlled Sedation (PCS) could provide a lighter sedation than general anesthesia adapted to the patient's individual requirement., Methods: Patients aged from 18 to 80 scheduled for elective colonoscopy were prospectively randomized to receive either standard sedation (control group) or patient-controlled-sedation (PCS). In the control group, patients received a continuous infusion of propofol. Patients in the PCS group were connected to an infusion pump containing propofol and self-administered 20-mg boluses as often as they required. An anesthetist was present throughout the procedure. Patient satisfaction measured on a visual analog scale four hours after colonoscopy was the main outcome criterion., Results: From December 2002 to September 2003, 402 patients underwent elective colonoscopy, 173 of them were eligible and were asked to participate in the study. Seventy-two gave their informed consent and were prospectively randomized. The patients' mean satisfaction scores were not statistically different between the two groups: 84.7 mm (PCS group) vs. 91.5 mm (control group); P = 0.24. Mean doses of propofol (60 mg vs. 248 mg; P <0.001), depth of sedation and time before discharge (1.75 hours vs. 4.45 hours) were significantly lower for patients in the PCS group; nine of them (25.7%) did not use the pump and had total colonoscopy without sedation. There were no statistically significant differences between the two groups regarding total duration of colonoscopy (19.4 min (PCS) vs. 18 min (control)) difficulty and therapeutic procedures (biopsy or polypectomy). Two weeks after the procedure, 96.5% of patients in the PCS group were willing to repeat the examination under the same conditions vs. 72.5% of patients in the control group (P = 0.03)., Conclusions: Our results demonstrate that need of sedation is widely overestimated in France. A subset of our patients is willing to consider colonoscopy without general anesthesia. For them, PCS with propofol is an effective and very well accepted form of sedation.

Unlabelled: Radiofrequency is an effective therapeutic modality for patients with hepatocellular carcinoma. However few data are available with regard to the complication rate, the feasibility and long term survival., Aims: To assess the response rate and complications of radiofrequency in cirrhotic patients with hepatocellular carcinoma., Patients and Methods: Eighteen patients were enrolled. Each nodule was treated subcutaneously. Treatment response was assessed by computed tomography performed at 24 hours in 10 patients and every 3 months in all patients. Necrosis of the tumor was considered complete when hypodensity without enhanced contrast., Results: Thirty hepatocellular carcinoma nodules with a mean tumor size of 30 mm; 15<30 mm and 15 >=30 mm, were treated by 1.3 radiofrequency sessions. Complete necrosis was achieved in 89%, greater for nodules<30 mm (100%) than for nodules >=30mm (80%). After a median follow up of 10.6 months, survival rate was 50%. Death was related to tumor involvement in 28%, to cirrhosis complications in 17% and to non liver-related disease in 5%. Three major treatment-related complications occurred (10%): subcapsular hematoma, sustained severe pain and peritoneal dissemination. All three complications were related to subcapsular location., Conclusion: Radiofrequency may be considered as an alternative treatment to percutaneous ethanol injection for hepatocellular carcinoma; however, subcapsular location has to be excluded when considering the observed morbidity. Prospective studies are warranted to evaluate the efficacy and morbidity of this treatment in hepatocellular carcinoma.

Polycystic liver disease, which is generally part of the autosomal dominant polycystic kidney disease, is often asymptomatic. We report a case of obstructive jaundice caused by compression of the biliary tract by a large haemorrhagic liver cyst. The patient was a man with sporadic polycystic liver disease without polycystic kidney disease and with normal renal function for his age. Ultrasound combined with cholangio-MRI provided non-invasive confirmation of intracystic bleeding and intrahepatic biliary dilatation. Obstructive jaundice was confirmed by cyst puncture-aspiration which resolved symptoms and normalized biology. The initial treatment of haemorrhagic liver cyst complicating polycystic liver disease must be medical with cyst aspiration-drainage and sclerotherapy to avoid surgery in these fragile patients.