BACKGROUND AND OBJECTIVES: There have been many studies about elevated bone conduction (BC) thresholds in patients with chronic otitis media (COM) with or without cholesteatoma and the relationships between operative techniques and postoperative changes of BC thresholds. The purposes of this study are evaluation of the effect of chronic otitis media on BC thresholds, the relationships between various operative techniques and postoperative BC threshold changes. MATERIALS AND METHODS: Preoperative BC thresholds in 237 patients with ipsilateral COM were evaluated and pre- and postoperative differences of BC thresholds were compared by each frequency in all patients. The patients were divided into three groups according to the severity of diseases: (1) Simple: relatively healthy middle ear mucosa and thus only simple mastoidectomy (SM) was done (N=92), (2) Severe: mastoidectomy with posterior tympanotomy (ICWM) or open cavity mastoidectomy (OCM) were done because of severe edematous middle ear mucosa, granulation tissues, or poor ventilation (N=89), (3) cholesteatomas (Chole, N=56). RESULTS: Preoperative audiograms revealed a significant relationship between the elevation of BC threshold and the severity of diseases. Postoperative BC thresholds were improved in 49% of SM (13.8 +/- 8.5), 51% of ICWM (13.8 +/- 6.1), and 35% of OCM (14.4 +/- 8.4), maintained in 45% of SM, 37% of ICWM, and 43% of OCM, but worsened in 6% of SM (-8.7 +/- 1.4), 12% of ICWM (-10.9 +/- 5.2), and 22% of OCM (-13.8 +/- 6.0). CONCLUSION: The preoperative BC threshold were maintained or improved in the majority of patients postoperatively. In OCM, more patients were worsened in BC hearing postoperatively than the others.
Bone Conduction* ; Cholesteatoma ; Ear, Middle ; Granulation Tissue ; Hearing ; Humans ; Mucous Membrane ; Otitis Media ; Ventilation

BACKGROUND/AIMS: ERCP is being used increasingly as a diagnostic and therapeutic tool for children with pancreaticobiliary disorders. Differences between thirteen pediatric ERCPs and adult ERCPs were reviewed with respect to their indications, method of anesthesia, choice of endoscope and complications. METHODS: The medical records of 13 ERCPs for 10 children (age: 23 months to 14 years) done between 2005 and 2008 were reviewed retrospectively. RESULTS: ERCP was indicated for gallstone pancreatitis (6), choledocholithiasis (3), and unexplained pain (1). The method of anesthesia was intravenous sedation with a single agent or a combination of midazolam, propofol or ketamine. The quality of sedation was satisfactory in 10 cases and unsatisfactory in three cases. These 3 cases were less than 8 years old and sedated with a combination of midazolam and propofol. Selective biliary cannulation was successful in 92.3% (12/13) of attempts. Therapeutic ERCP included sphincterotomy (4), endoscopic papillary balloon dilatation (3), and both (5). Complications occurred in 7.7% of attempts (1/13; 1 duodenal perforation) which was successfully managed by surgery. CONCLUSIONS: Pediatric ERCP is a feasible and useful technique. Special caution is needed, however, because of differences with adult ERCP in terms of the effectiveness of intravenous sedation, complications, and size of the gastrointestinal tract.
Adult ; Anesthesia ; Catheterization ; Child ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Dilatation ; Endoscopes ; Gallstones ; Gastrointestinal Tract ; Humans ; Ketamine ; Medical Records ; Midazolam ; Pancreatitis ; Propofol ; Retrospective Studies

Radiofrequency ablation (RFA) has been accepted as a safe and effective treatment for unresectable hepatic tumors because of the advantages of a minimally invasive procedure and the local treatment effect. Although RFA can be performed safely in most patients, early and late complications related to mechanical or thermal damage may be observed at follow-up examination. Hemobilia is a very rare complication of RFA and most hemobilia is an immediate complication. However, delayed hemobilia is an even more rare complication after RFA and is known to be a fatal complication. We present a case of delayed fatal hemobilia after RFA for hepatocellular carcinoma.
Carcinoma, Hepatocellular ; Follow-Up Studies ; Hemobilia ; Humans

Synchronous anal squamous cell carcinoma with colorectal adenocarcinoma is a very rare and interesting disease entity because these neoplasms are essentially different from each other in terms of their anatomical locations, clinical behaviors, histopathological characteristics and treatment. To date, there have been very few case reports regarding the concurrent occurrence of these two distinct neoplasms. Nonetheless, it is recommended that patients with squamous cell carcinoma of the anus and who are older than 50 years should undergo colonoscopy in order to rule out a synchronous colorectal neoplasm. We recently encountered a 72-year-old woman who presented with synchronous squamous cell carcinoma of the anal canal and adenocarcinoma of the rectosigmoid junction. The patient underwent curative surgical resection for the colorectal adenocarcinoma and chemoradiotherapy for the concurrent anal squamous cell carcinoma. We describe here our clinical experience with this unusual case and we also conduct a short review of relevant literature.
Adenocarcinoma ; Aged ; Anal Canal ; Anus Neoplasms ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms ; Female ; Humans

Ulcerative colitis produces repeated improvements and relapses of chronic colonic inflammation. Complications of the disease can include bleeding, toxic megacolon, colon cancer, or colon stricture. While colonic strictures are common in Crohn's disease, this complication rarely appears in ulcerative colitis cases. Unlike in Crohn's disease, where strictures are commonly treated by endoscopic balloon dilatation, surgical management is the basis for treatment of strictures in ulcerative colitis because malignant strictures are common and because the stricture region is generally wide. We report the case of a patient who presented with decreased stool caliber while undergoing treatment for ulcerative colitis. We performed therapeutic balloon dilatation in this patient with a benign stricture caused by ulcerative colitis and experienced improvement of symptoms.
Colitis, Ulcerative ; Colon ; Colonic Neoplasms ; Constriction, Pathologic ; Crohn Disease ; Dilatation ; Hemorrhage ; Humans ; Inflammation ; Megacolon, Toxic ; Recurrence ; Ulcer

Argon Plasma Coagulation (APC), a new endoscopic hemostatic method of non-contact electrocoagulation, is widely used for ablation of Barrett's esophagus, residual tissue after polypectomy, palliation of malignancy and hemostasis of radiation proctopathy, bleeding peptic ulcers, prevention of esophageal varices. Although a safe and effective procedure, if used inappropriately, side effects such as failure of hemostasis, perforation, asymptomatic submucosal emphysema, and pneumoperitoneum can occur. Perforations progressing to peritonitis require surgery, but a pneumoperitoneum can recover with conservative treatment. Therefore, clinicians should distinguish these two different cases. There are no domestic cases of asymptomatic pneumoperitoneum caused by APC. In two cases treated by endoscopic submucosal dissection of polypectomy and early gastric cancer, asymptomatic pneumoperitoneum occurred after argon plasma coagulation treatment. We present these two cases of asymptomatic pneumoperitoneum treated successfully by conservative treatment without complications.
Argon ; Argon Plasma Coagulation ; Barrett Esophagus ; Electrocoagulation ; Emphysema ; Esophageal and Gastric Varices ; Hemorrhage ; Hemostasis ; Peptic Ulcer ; Peritonitis ; Pneumoperitoneum ; Stomach Neoplasms

Pseudomelanosis duodeni is a rare benign condition that manifests endoscopically as diffuse, small brownish-black spots in the duodenal mucosa, and the histochemical findings show an accumulation of hemosiderin pigment in the duodenal villi's lamina propria. This condition produces no specific symptoms, and it may be reversible. The cause and natural history of the pigmentation have not been clarified, although it is associated with a variety of systemic illnesses and medications. We describe two cases of pseudomelanosis duodeni and the patients had histories of diabetes mellitus, hypertension, chronic renal insufficiency and specific medications. We also review the relevant medical literature on this rare condition.
Diabetes Mellitus ; Duodenum ; Hemosiderin ; Humans ; Hypertension ; Iron ; Melanosis ; Mucous Membrane ; Natural History ; Pigmentation ; Renal Insufficiency, Chronic

Ischemic colitis is the most prevalent form of ischemic vascular compromise of the gastrointestinal tract. Although frequent in the elderly with co-morbidity, numerous pharmacologic agents including diuretics, pseudoephedrine, nonsteroidal anti-inflammatory drugs, oral contraceptives, and cocaine may produce colonic ischemia by mesenteric vasoconstriction. Oral hyperosmotic laxatives are frequently used as cleansing agents in bowel preparation for both radiologic and endoscopic studies. They are regarded as safe and effective agents, but can produce a rapid osmotic-mediated fluid loss, resulting in transient meseneteric hypoperfusion and subsequent ischemic colitis. Here, we describe a case of acute ischemic colitis caused by the oral osmotic laxative magnesium citrate, which was given for bowel preparation before a barium enema in a young healthy patient without underlying disease.
Aged ; Barium ; Citric Acid ; Cocaine ; Colitis ; Colitis, Ischemic ; Colon ; Colonoscopy ; Contraceptives, Oral ; Detergents ; Diuretics ; Enema ; Gastrointestinal Tract ; Humans ; Ischemia ; Laxatives ; Magnesium ; Organometallic Compounds ; Pseudoephedrine ; Vasoconstriction

Suture granuloma is a benign, rare complication of surgical intervention and it is known to occur after the use of non-absorbable suture materials deep within the skin. Although suture granuloma can occur anywhere in the body after a variety of operations, its incidence has rapidly diminished in recent years since the widespread use of absorbable suture materials. Clinically, making the differential diagnosis with recurrent cancer is obviously important for a cancer patient because postoperative suture granuloma can mimic local tumor recurrence after surgical resection. We recently encountered a case of rectal suture granuloma in a patient with rectal cancer and who underwent low anterior resection 4 years previously. The diagnosis was made according to the characteristic image findings of endoscopic ultrasonography and the abdominal CT scan. The patient was successfully treated with broad-spectrum antibiotics, US-guided incision and drainage. We report here on a rare case of rectal suture granuloma and we briefly review the relevant literature.
Anti-Bacterial Agents ; Diagnosis, Differential ; Drainage ; Endosonography ; Granuloma ; Humans ; Hydrazines ; Incidence ; Rectal Neoplasms ; Rectum ; Recurrence ; Skin ; Sutures

There are various causes of acute pancreatitis, and accurately determining the etiology is pivotal for selecting appropriate management. Other hidden causes, such as congenital anomaly, should be considered in patients with recurrent abdominal pain or unexplained recurrent pancreatitis. A santorinicele is a focal cystic dilatation of the terminal dorsal pancreatic duct, and this is usually associated with pancreas divisum and it is a risk factor for acute pancreatitis due to the accompanying relative stenosis of the minor papilla. We present here the case of a patient who was treated for acute pancreatitis that was presumably was caused by either Rifampin or Brucellosis, and the patient recovered with conservative management. However, we eventually diagnosed pancreas divisum with santorinicele by performing MRCP and ERCP after the pancreatitis had relapsed. We report here on a case of successful endoscopic treatment for pancreas divisum with santorinicele as a cause of recurrent pancreatitis, and this was initially confused with drug or infection related pancreatitis.
Abdominal Pain ; Brucellosis ; Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Dilatation ; Humans ; Pancreas ; Pancreatic Ducts ; Pancreatitis ; Rifampin ; Risk Factors