BACKGROUND/AIMS: Colonoscopy is the principal method for diagnosis, treatment, and follow up of colorectal disease. The study aimed to assess the incidence, clinical features, and management of colonoscopic perforations at a local general hospital. METHODS: A retrospective review of patient record was performed for all patients with iatrogenic colonic perforation after sigmoidoscopy and colonoscopy between 1997 and 2007. RESULTS: In the 10-year period, 16,388 colonoscopic and sigmoidscopic procedure were performed. All 10 cases of procedure related colonic perforation were developed. Perforation occurred in 9 cases during therapeutic procedure; 5 cases due to polypectomy and 4 cases due to endoscopic submucosal dissection. Perforation occurred in one case during diagnostic procedure. CONCLUSIONS: Therapeutic procedure is a clear risk factor of colonic perforation. When colonic perforation occurs, we should be able to make early diagnosis. Early diagnosis can lead to a good treatment and can produce good prognosis with short hospital days.
Colonic Diseases/diagnosis/epidemiology/*etiology ; Colonoscopy/*adverse effects ; Humans ; *Iatrogenic Disease/epidemiology ; Incidence ; Intestinal Perforation/*diagnosis/epidemiology/*etiology ; Prognosis ; Retrospective Studies ; Risk Factors ; Sigmoidoscopy/adverse effects

BACKGROUND: Scrub typhus is a febrile zoonosis resulting from infection with Orientia tsutsugamushi. Attentions for tsutsugamushi disease are growing about its ecologic, epidemiologic and clinical characteristics according to increasing patients and these studies were helpful to understand the pathophysiology and many clinical features of tsutsugamushi disease. Although scrub typhus has been treated successfully with the introduction of effective antibiotics, life-threatening serious complications including gastrointestinal bleeding were still remained. The authors here intended to describe different endoscopic characteristics of the gastrointestinal manifestation of tsutsugamushi disease, and then to evaluate the clinical significance of upper gastrointestinal endoscopic feature and clinical severity index (CSI) as the predictable factors for clinical severity of tsutsugamushi disease. METHODS: One hundred and forty two patients who were diagnosed as tsutsugamushi disease at Masan-Samsung Hospital from January 2001 to December 2002 were enrolled. Patients were recommended to be taken upper gastrointestinal endoscopy irrespective of abdominal symptoms and 40 patients were classified into 5 degrees by endoscopic findings. All patients were classified by CSI based on clinical symptoms and laboratory findings. Correlations among CSI, hospital stay, and endoscopic grade were analyzed. RESULTS: The older patients (p=0.0018) and the patients with lower serum hemoglobin (p=0.0049), lower serum albumin (p<0.0001), higher serum bilirubin (p=0.0109), higher BUN (p<0.0001) and creatinine (p=0.0223), and longer activated prothrombin time (p=0.0193) had significantly longer hospital stay. The patients with longer hospital stay had significantly severe esophagogastroduodenoscopic (EGD) findings (p=0.0017). Patients with higher CSI score had significantly longer hospital stay (p=0.0069) and more severe EGD finding (p=0.0062). CONCLUSIONS: There were significant correlations between CSI, hospital stay, and EGD grade in this study. CSI and endoscopic feature may be useful as the predictable factors for clinical severity in tsutsugamushi disease.
Anti-Bacterial Agents ; Attention ; Bilirubin ; Creatinine ; Endoscopy, Gastrointestinal ; Hemorrhage ; Humans ; Length of Stay ; Orientia tsutsugamushi ; Prothrombin Time ; Scrub Typhus* ; Serum Albumin

BACKGROUND/AIMS: The objective of this study was to compare the degree of hepatic enhancement and image quality using contrast media of different iodine concentrations with the same iodine dose. METHODS: From July 2011 to June 2013, 50 patients with chronic liver disease who underwent baseline and follow-up 128-slice multidetector computed tomography(MDCT) using contrast media with 350 mg I/mL (group A) and 400 mg I/mL (group B) iodine concentrations were included in this prospective study. The patients were randomly allocated to one of two protocols: 350 mg I/mL initially and then 400 mg I/mL; and 400 mg I/mL initially and then 350 mg I/mL. The bolus tracking technique was used to initiate the arterial phase scan. The computed tomography values of hepatic parenchyma, abdominal aorta and portal vein were measured. The degrees of hepatic and vascular enhancement were rated on a 4-point scale for qualitative assessment. The paired Student t test was used to compare outcome variables. RESULTS: The mean hepatic enhancement was significantly higher in group B than in group A during the portal (p = 0.025) and equilibrium phases (p = 0.021). In all phases, group B had significantly higher mean liver-to-aorta contrast (p < 0.05) and mean visual scores for hepatic and vascular enhancement (p < 0.001). CONCLUSIONS: This study showed that a higher iodine concentration (400 mg I/mL) in contrast media was more effective at improving hepatic enhancement in portal and equilibrium phase images and overall image quality using 128-slice MDCT in chronic liver disease patients.
Aorta, Abdominal ; Contrast Media ; Follow-Up Studies ; Humans ; Iodine* ; Liver Diseases* ; Liver* ; Multidetector Computed Tomography* ; Portal Vein ; Prospective Studies

No abstract available.
Humans ; Listeria* ; Meningitis, Listeria*

An esophageal submucosal gland duct adenoma is a rare benign disease. We report a 58-year-old man who presented with an esophageal submucosal tumor on health screening endoscopy. The endoscopic examination showed a round elevated lesion with central depression at the mid-esophagus. On endoscopic ultrasonography, an anechoic lesion with some hyperechoic septal structures measuring 8 mm in the largest diameter was observed in the third layer. We resected the lesion endoscopically. Histologically, there were several dilated gland ducts, with proliferation of the inner epithelial and outer myoepithelial cell layers. These findings were compatible with a submucosal gland duct adenoma of the esophagus.
Adenoma ; Depression ; Endoscopy ; Endosonography ; Esophagus ; Humans ; Mass Screening ; Middle Aged

The incidence of serious cardiac complications associated with esophagogastro-duodenoscopic examination is very rare. An episode of cardiac arrest developed in 49-year-old during endoscopic examination. The patient had no history of pulmonary or ischemic heart disease. After cardiopulmonary resuscitation, he recovered completely. In this patient, we were able to demonstrate a focal spasm by coronary angiography.
Cardiopulmonary Resuscitation ; Coronary Angiography ; Coronary Vasospasm* ; Endoscopy, Digestive System* ; Heart Arrest ; Humans ; Incidence ; Middle Aged ; Myocardial Ischemia ; Spasm

The incidence of serious cardiac complications associated with esophagogastro-duodenoscopic examination is very rare. An episode of cardiac arrest developed in 49-year-old during endoscopic examination. The patient had no history of pulmonary or ischemic heart disease. After cardiopulmonary resuscitation, he recovered completely. In this patient, we were able to demonstrate a focal spasm by coronary angiography.
Cardiopulmonary Resuscitation ; Coronary Angiography ; Coronary Vasospasm* ; Endoscopy, Digestive System* ; Heart Arrest ; Humans ; Incidence ; Middle Aged ; Myocardial Ischemia ; Spasm

Typhoid fever is a febrile illness with a variety of systemic manifestations; however, icteric typhoid hepatitis, mimicking the clinical features of acute hepatitis, is very uncommon. A 45-year-old man was admitted to the hospital for evaluation of fever, dark-colored urine, and jaundice. On admission, the total bilirubin was 4.3 mg/dL, and the AST and ALT were 468 and 319 IU/L, respectively. Salmonella typhi was identified by blood culture. A liver biopsy revealed some mononuclear cell infiltrations without hepatocyte necrosis or typhoid nodules. CT scan findings showed splenomegaly and mesenteric lymphadenopathy. With the administration of ceftriaxone, he became afebrile and showed improvement in the jaundice, with normalization of AST and ALT.
Bilirubin ; Biopsy ; Ceftriaxone ; Fever ; Hepatitis ; Hepatocytes ; Humans ; Jaundice ; Liver ; Lymphatic Diseases ; Middle Aged ; Necrosis ; Salmonella typhi ; Splenomegaly ; Typhoid Fever

The occurrence of duodenal varices is rare. They are often overlooked as a source of upper gastrointestinal bleeding in patients with portal hypertension. Experience in control of bleeding duodenal varices is limited. Endoscopic variceal ligation (EVL) is generally considered a safer alternative than endoscopic injection sclerotherapy for treatment of bleeding esophageal varices. Recently EVL has been described as a successful treatment for ruptured duodenal varices. We present a case of bleeding duodenal varices in a 46-year-old man with liver cirrhosis and cholangiocarcinoma who presented with melena. Emergency endoscopy revealed no esophagogastric varices, but several nodular varices were found in the second portion of the duodenum. A punctate ulcer overlying the varix with intermittent bleeding was observed. The hemorrhagic lesion was successfully treated by endoscopic ligation after failure of hemostasis with ethanolamine injection theapy. Endoscopic ligation may be a therapeutic choice to arrest active duodenal variceal bleeding.
Cholangiocarcinoma ; Duodenum ; Emergencies ; Endoscopy ; Esophageal and Gastric Varices ; Ethanolamine ; Hemorrhage* ; Hemostasis ; Humans ; Hypertension, Portal ; Ligation* ; Liver Cirrhosis ; Melena ; Middle Aged ; Sclerotherapy ; Ulcer ; Varicose Veins*

Recent studies have shown that circulating microRNAs are a potential biomarker in various types of malignancies. The aim of this study was to investigate the feasibility of using serum exosomal microRNAs as novel serological biomarkers for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). We measured the serum exosomal microRNAs and serum circulating microRNAs in patients with CHB (n=20), liver cirrhosis (LC) (n=20) and HCC (n=20). Serum exosomal microRNA was extracted from 500 mul of serum using an Exosome RNA Isolation kit. The expression levels of microRNAs were quantified by real-time PCR. The expression levels of selected microRNAs were normalized to Caenorhabditis elegans microRNA (Cel-miR-39). The serum levels of exosomal miR-18a, miR-221, miR-222 and miR-224 were significantly higher in patients with HCC than those with CHB or LC (P<0.05). Further, the serum levels of exosomal miR-101, miR-106b, miR-122 and miR-195 were lower in patients with HCC than in patients with CHB (P=0.014, P<0.001, P<0.001 and P<0.001, respectively). There was no significant difference in the levels of miR-21 and miR-93 among the three groups. Additionally, the serum levels of circulating microRNAs showed a smaller difference between HCC and either CHB or LC. This study suggests that serum exosomal microRNAs may be used as novel serological biomarkers for HCC.
Adult ; Aged ; Biomarkers, Tumor/blood/genetics ; Carcinoma, Hepatocellular/blood/diagnosis/*genetics ; Exosomes/genetics ; Female ; Gene Expression Profiling ; Humans ; Liver/pathology ; Liver Neoplasms/blood/diagnosis/*genetics ; Male ; MicroRNAs/blood/*genetics ; Middle Aged