Prevalence of and risk factors for endogenous endophthalmitis in patients with pyogenic liver abscesses

BACKGROUND/AIMS: Although pyogenic liver abscesses (PLAs) can be successfully treated, the visual prognosis of patients with endogenous endophthalmitis (EE) associated with a PLA is poor. Early diagnosis and prompt intervention may salvage useful vision. Therefore, we investigated risk factors for EE in patients with PLA, to facilitate early diagnosis. METHODS: Data from 626 patients diagnosed with PLA between January 2004 and July 2013 were analyzed retrospectively. Patients were divided into two groups: those with liver abscess-associated endogenous endophthalmitis (LAEE) and non-LAEE. RESULTS: The prevalence of EE in PLA patients was 1.92%. The mean age for all patients (373 males, 59.6%) was 62.8 years. Upon multivariate logistic regression, a liver abscess or another systemic infection (odds ratio [OR], 5.52; p = 0.005), an abscess in the right superior segment (OR, 5.26; p = 0.035), and Klebsiella pneumoniae infection (OR, 3.68; p = 0.039), were risk factors for LAEE. The final visual outcomes of patients with LAEE included no light perception in seven, hand motion only in three, and decreased visual acuity in two. Vitrectomy and early intravitreal injections of antibiotics improved visual acuity and preserved useful vision. CONCLUSIONS: PLA patients with other systemic infections, abscesses in the right superior segment, and K. pneumoniae infection require close monitoring and early intervention to treat LAEE. Intravitreal antibiotic injections or early vitrectomy may salvage useful vision.

Role of Balloon-Sheathed Intraductal Ultrasonography for Patients with Extensive Pneumobilia

Intraductal ultrasonography (IDUS) is one of the most useful diagnostic tools for various extrahepatic biliary diseases. However, conventional IDUS has some limitations in providing accurate cross-sectional imaging of the bile duct in patients with extensive pneumobilia. Using a balloon-sheathed catheter, the US system (balloon-sheathed IDUS) can overcome these limitations. Sixteen patients underwent balloon-sheathed IDUS during endoscopic retrograde cholangiography. The balloon-sheathed IDUS was inserted via a transpapillary route when visualization of the bile duct with conventional IDUS was distorted by extensive pneumobilia. The patient group had a mean age of 65.5 years, and 56.3% (9/16) were male. The balloon-sheathed IDUS permitted successful visualization of the bile duct in all patients, regardless of the extent of pneumobilia. Using this system, remnant common bile duct stones were detected in five patients (31.3%), and cholangiocarcinoma was detected in one patient (6.3%). The balloon-sheath IDUS aided in stone sweeping. No significant complications, including bleeding, perforation, or pancreatitis, occurred in any of the patients. The balloon-sheathed catheter US system was useful and safe for biliary IDUS in patients with extensive pneumobilia.

A Clinical Study of Colon Diseases of Old Age Based on Colonoscopic Finding

BACKGROUND: Recently, geriatric diseases become the matter of concern, and the neoplastic lesion of colon including polyp and cancer by the western-style diet is increasing. The aims of this study were to assess the relations between colon diseases, clinical manifestations and features of colonoscopic finding in elderly. METHODS: We retrospectively evaluated records of 764 patients underwent colonoscopy. Colonoscopic finding, each colon diseases and lower gastrointestinal symptoms were analyzed to compare between two groups, which are 416 elders aged over 65 and control of 348 adults aged from 25 to 65. RESULTS: Both two groups underwent colonoscopy showed lower abdominal pain is the most symptom of lower gastrointestinal symptoms. But, anaemia and bowel habit change were significantly high frequency in the elderly group while diarrhea appeared in the control group(p<0.05). Colon polyp and cancer were significantly increased frequency in the elderly group(p<0.05). Symptoms such as diarrhea and hematochezia were significantly high in case of colon polyp of elderly group(p<0.05). But in case of colon cancer, lower abdominal pain had significantly high in the control group compared with the elderly group who had various lower gastrointestinal symptoms such as constipation, diarrhea, hematochezia, bowel habit change(p<0.05). CONCLUSIONS: As people getting older, the incidence of colon polys and cancer is higher, and non-specific, various clinical manifestations are seen. Therefore, we think that seniors who have change in bowel habit, abdominal pain, hematochezia or constipation need colonoscopy increasingly and should pay attention to find neoplastic lesions.

Clinical Analysis of Upper Gastrointestinal Diseases in Elderly Patients Underwent Esophagogastroduodenoscopy

Background: Recently the elderly people have increased in Korea. So, the interest of upper gastrointestinal diseases have increased. Our aim was to determine clinical characteristics of upper gastrointestinal diseases in the elderly patients underwent esophagogastroduodenoscopy. Methods: We investigated clinical characteristics of 1190 elderly patients aged 65 years or older and 952 controls aged 64 years or younger who underwent esophagogastrodu odenoscopy in Seonam University Hospital from Jan. 2000 to Dec. 2004. retrospecti vely. Only two main symptoms were included among symptoms of two or over. The endoscopic findings were in the same manner. Results: The average age were 73.9 (+/-7.25)-year-old in the elderly, and 47.2 (+/-11.32)-year-old in controls. The most common symptom was dyspepsia in the elderly and in controls. The most common endoscopic findings showed chronic atrophic gastritis in the elderly, and chronic erythematous & erosive gastritis in controls. 64% was positive in 424 cases performed rapid urease test in the elderly and 63% was positive in controls. The most common associated diseases was hypertension in both group. The history of Non-steroidal anti-inflammatory drugs and aspirins were 21% in the elderly, and 15% in controls. Conclusion: We found that dyspepsia was the most common symptom in the elderly and controls underwent esophagogastroduodenoscopy. The most common upper intestinal disease was chronic atrophic gastritis in the elderly. We recommend esophagogastroduodenoscopy for the elderly patients in regular interval because they may have vague and atypical symptoms or asymptom.

Idiopathic Granulomatous Appendicitis: A case report

Crohn's disease is a chronic condition characterized by a non-specific granulomatous necrosis involving potentially any location in the alimentary tract, but a primary lesion confined to the appendix alone is very rare. It is difficult to discriminate Crohn's appendicitis from acute appendicitis preoperatively because of their clinical similarities. Because Crohn's disease confined to the appendix has a more favorable prognosis than typical Crohn's disease, it is considered a separate disease from Crohn's disease. Recently, the term idiopathic granulomatous appendicitis has gained wide acceptance as a distinct disease entity. We experienced a case of Crohn's disease giving rise to appendicitis or idiopathic granulomatous appendicitis and report a case with a review of the literature.