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: 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

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

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

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

BACKGROUND/AIMS: Controversy remains over the optimal approach to preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma. We compared the clinical outcomes of endoscopic biliary drainage (EBD) with those of percutaneous transhepatic biliary drainage (PTBD) in patients undergoing preoperative biliary drainage for perihilar cholangiocarcinoma. METHODS: A total of 106 consecutive patients who underwent biliary drainage before surgical treatment were divided into two groups: the PTBD group (n=62) and the EBD group (n=44). RESULTS: Successful drainage on the first attempt was achieved in 36 of 62 patients (58.1%) with PTBD, and in 25 of 44 patients (56.8%) with EBD. There were no significant differences in predrainage patient demographics and decompression periods between the two groups. Procedure-related complications, especially cholangitis and pancreatitis, were significantly more frequent in the EBD group than the PTBD group (PTBD vs EBD: 22.6% vs 54.5%, p<0.001). Two patients (3.8%) in the PTBD group experienced catheter tract implantation metastasis after curative resection during the follow-up period. CONCLUSIONS: EBD was associated with a higher risk of procedure-related complications than PTBD. These complications were managed properly without severe morbidity; however, in the PTBD group, there were two cases of cancer dissemination along the catheter tract.
Aged ; Aged, 80 and over ; Bile Duct Neoplasms/*surgery ; Bile Ducts/surgery ; Cholangitis/etiology ; Drainage/adverse effects/*methods ; Endoscopy, Gastrointestinal/adverse effects/*methods ; Female ; Humans ; Klatskin Tumor/*surgery ; Liver/surgery ; Male ; Middle Aged ; Pancreatitis/etiology ; Postoperative Complications/etiology ; Preoperative Care/adverse effects/*methods ; Treatment Outcome

BACKGROUND/AIMS: A number of studies have reported wide variability in the colonoscope insertion time among patients who had prior abdominal surgery. The aim of this study was to investigate the effect of abdominal surgery on colonoscope insertion time. METHODS: The subjects were 192 patients with prior abdominal surgery, among 3,600 patients who underwent a colonoscopy at Samsung Changwon Hospital from May 2008 to May 2010. We collected the following data: insertion time, age, gender, height, weight, BMI, waist circumference, method of abdominal surgery, and the degree of bowel cleanliness. Previous abdominal operations were divided into colectomy, non-colectomy abdominal surgery, pelvic surgery, and laparoscopic surgery groups. RESULTS: The average colonoscope insertion time in patients with prior abdominal surgery (7.73+/-5.95 min) was longer than that of the non-surgery group (6.4+/-3.88 min). Patients in the colectomy groups were older and had a shorter insertion time (5.11+/-3.32 min) than patients in the other groups. CONCLUSIONS: Insertion of a colonoscope in patients with previous abdominal surgery was more difficult than that in the control group, except the colectomy group.
Colectomy ; Colonoscopes ; Colonoscopy ; Humans ; Laparoscopy ; Waist Circumference

BACKGROUND/AIMS: Although it has been known that folate will participate in colorectal carcinogenesis, the relationship between blood folate level and colorectal cancer is less consistent. The blood folate level does not reflect the systemic folate status. By contrast, serum homocysteine has become a sensitive marker for the folate deficiency. We attempted to explain the correlation between folate and colorectal cancer according to the serum homocysteine level. METHODS: We reviewed the clinical records, including alcohol history of 184 patients taking the colonoscopy and measurement of the serum homocysteine level at Health Promotion Center from 2001 to 2002. One hundred fifty-one of 184 were included, excluding 33 patients with previous history of colonic polyp, cerebrovascular, cardiovascular attack and thromboembolism. They were divided into the normal control (n=111) and the adenomatous polyp group (n=40). We had selected the colorectal cancer group (n=50) from the collection list of the tissue and blood bank less than 3 months storage interval. RESULTS: There was no significant difference in the mean serum homocysteine level among three groups. However, in the subjects with high alcohol consumption, there was a significant difference in the mean serum homocysteine between the normal control (n=7) and the adenomatous polyp group (n=9) (10.2 vs 15.1 micromol/L, p<0.05). CONCLUSIONS: There was no correlation of serum homocysteine and colorectal tumor. However, in the subjects with high alcohol consumption, high serum homocysteine might be related to the development of adenomatous polyp.
Adenomatous Polyps/*blood/pathology ; Alcohol Drinking/blood ; Colonoscopy ; Colorectal Neoplasms/*blood/pathology ; Female ; Homocysteine/*blood ; Humans ; Male ; Middle Aged

BACKGROUND/AIMS: As the population ages, endoscopic retrograde cholangiopancreaticography (ERCP) is being used increasingly as a diagnostic and therapeutic tool for elderly patients with pancreatobiliary disease. The aim of this study was to assess the outcomes, safety and complications associated with ERCP performed in the elderly patients. METHODS: We retrospectively reviewed the medical record of 596 patients who were 50 years of age or older and underwent ERCP from January 2005 to September 2010. The patients were classified into two groups according to the age: non-elderly, 50-74 years old and elderly, > or =75 years old. Comparisons were made between two groups. RESULTS: Five hundred and ninety-six patients (132 elderly and 464 non-elderly patients) were enrolled. The success rate of ERCP was 89.4% in the elderly and 91.9% in the non-elderly. The major complications were occurred in 11 patients of the elderly and 16 of the non-elderly, and the complication rate was significantly higher in the elderly compared to the non-elderly (8.3% vs. 3.4%, p=0.011). Pancreatitis occurred in 2 elderly patients and 10 non-elderly patients (1.5% vs. 2.1%, p=1.0). There was a higher rate of bleeding in the elderly patients (4.5% vs. 1.3%, p=0.01). CONCLUSIONS: ERCP is effective and safe even in elderly patients. Outcomes of diagnostic and therapeutic ERCP in the elderly patients were similar to those in non-elderly patients. Elderly patients undergoing ERCP carried similar risk of pancreatitis but a higher risk of bleeding and perforation compared to non-elderly patients.
Aged ; Aged, 80 and over ; Cholangiopancreatography, Endoscopic Retrograde/*adverse effects ; Female ; Hemorrhage/etiology ; Humans ; Male ; Middle Aged ; Pancreatitis/etiology

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