The area of endoscopic application has been continuously expanded since its introduction in the last century and the frequency of its use also increased stiffly in the last decades. Because gastrointestinal endoscopy is naturally exposed to diseased internal organs and contact with pathogenic materials, endoscopy mediated infection or disease transmission becomes a major concern in this field. Gastrointestinal endoscopy is not for single use and the proper reprocessing process is a critical factor for safe and reliable endoscopy procedures. What needed in these circumstances is a practical guideline for reprocessing the endoscope and its accessories which is feasible in the real clinical field to guarantee acceptable prevention of pathogen transmission. This guideline contains principles and instructions of the reprocessing procedure according to the step by step. And it newly includes general information and updated knowledge about endoscopy-mediated infection and disinfection. Multiple societies and working groups participated to revise; Korean Association for the Study of the Liver, the Korean Society of Infectious Diseases, Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Society of Gastroenterology, Korean Society of Gastrointestinal Cancer, Korean Association for the Study of Intestinal Diseases, Korean Pancreatobiliary Association, the Korean Society of Gastrointestinal Endoscopy Nurses and Associates and Korean Society of Gastrointestinal Endoscopy. Through this cooperation, we enhanced communication and established a better concordance. We still need more researches in this field and fill up the unproven area. And our guidelines will be renewed accordingly.

BACKGROUND: Regulatory T cells (Tregs) may contribute to the immunological hyporesponsiveness against hepatitis B virus (HBV), and this can result in chronic infection. Tregs suppress the T cell responses directed against HBV and they protect hepatocytes by down-regulating the immune responses that cause liver damage, but the role of Tregs has not been well characterized. METHODS: Fifty four patients were selected and classified into three groups (12 were in the immune-tolerance phase, 35 were in the immune-clearance phase and 7 were in the asymptomatic virus carrier phase). We examined the frequency of CD3+, CD4+ & CD8+ T cells and forkhead box P3 (FoxP3)+ Tregs in the needle-biopsied liver tissue by performing immunohistochemistry. RESULTS: The FoxP3+ Tregs were mainly located at the portal tracts. In the immune-clearance phase, the frequency of FoxP3+ Tregs was significantly increased compared to that of the immune-tolerance group and the asymptomatic carrier group. Increased FoxP3+ T cells were observed in the patients with a higher histologic inflammatory index. No correlation was observed among the numbers of FoxP3+ Tregs, the serum alanine aminotransferase level, detection of HBeAg and the HBV-DNA viral load. CONCLUSIONS: FoxP3+ Tregs may play important roles in suppressing the immune response to HBV and the complete elimination of HBV.
Alanine Transaminase ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Hepatocytes ; Humans ; Liver ; T-Lymphocytes ; T-Lymphocytes, Regulatory ; Viruses

Primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma (CSMTCL) is a rare disease constituting 2% of all cutaneous T-cell lymphomas. In most cases, CSMTCL occurs as a solitary lesion and has an indolent course. Here we present a 42-year-old woman with multiple, localized, recurrent, erythematous papules and macules that developed after combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP).
Adult ; Cyclophosphamide ; Doxorubicin ; Drug Therapy, Combination ; Female ; Humans ; Lymphoma ; Lymphoma, T-Cell ; Lymphoma, T-Cell, Cutaneous ; Prednisolone ; Rare Diseases ; T-Lymphocytes ; Vincristine

Incontinentia pigmenti is a systemic disorder affecting the skin, teeth, eyes, nervous tissue, hair, nails, musculoskeletal system, and heart. We describe an 11-month-old girl with incontinentia pigmenti associated with a ventricular septal defect, left hemiatrophy, hemangiomas, an abnormal labial frenum, and spastic cerebral palsy manifested as left hemiplegia and developmental delay. We believe this patient illustrates that incontinentia pigmenti is a systemic disorder necessitating a multidisciplinary approach to management.
Cerebral Palsy ; Eye ; Hair ; Heart ; Heart Septal Defects, Ventricular ; Hemangioma ; Hemiplegia ; Humans ; Incontinentia Pigmenti ; Infant ; Labial Frenum ; Musculoskeletal System ; Nails ; Skin ; Tooth

Although injectable soft-tissue augmentation materials are extremely well-tolerated, undesirable effects sometimes occur. Whereas minor adverse events such as erythema, edema or bruising are generally reversible, the formation of foreign body granuloma, atypical mycobacterial infections or tissue necrosis may cause serious irreversible damages and disfigurement. We present here the case of a 50-year-old woman with an indurated painful nodule and patch on the right cheek, and this occurred after an unlicensed nonspecialist injected filler of unknown ingredients. The histopathologic findings showed granulomatous inflammation composed of lymphocytes, histiocytes and multinucleated giant cells with a Swiss cheese appearance. Although any acid-fast bacilli were not observed on Ziehl-Neelsen staining, the mycobacterial culture demonstrated an ivory-colored wet colony that was identified as M. chelonae by polymerase chain reaction-restriction fragment length polymorphism. The patient was treated with 1 g of clarithromycin for seven weeks, and the lesion improved considerably.
Cheek ; Cheese ; Clarithromycin ; Edema ; Erythema ; Female ; Foreign Bodies ; Giant Cells ; Granuloma, Foreign-Body ; Histiocytes ; Humans ; Inflammation ; Lymphocytes ; Middle Aged ; Mycobacterium ; Mycobacterium chelonae ; Necrosis

BACKGROUND: Epidermal growth factor receptor (EGFR) inhibitors are associated with cutaneous adverse events, including papulopustular eruption, xerosis, paronychia, hair abnormality and mucositis. In particular, acneiform eruptions might serve as the visible markers of anti-tumor activity and the therapeutic efficacy of EGFR inhibitors. OBJECTIVE: Our aims are to investigate the common cutaneous adverse events induced by cetuximab, which is one of the EGFR inhibitors approved by the US Food and Drug Administration, and to analyze whether the presence and severity of papulopustular eruptions have a correlation with the tumor response. METHODS: We retrospectively reviewed the medical records and clinical photographs of 114 Korean patients who had been treated with cetuximab at Asan Medical Center from September 2004 to March 2007. Results: Papulopustular eruptions occurred in 100 patients (87.7%) and this usually happened 10 days after starting chemotherapy. There was a tendency that the better the tumor responded to the chemotherapeutic agents including cetuximab, the more severe were the papulopustular eruptions. The papulopustular eruptions prominently improved after the treatment with topical agents such as benzoyl peroxide, metronidazole, clindamycin and retinoid, and with systemic agents such as minocycline and tetracycline, and there was no adverse event induced by this treatment for papulopustular eruptions. Xerosis appeared in 67 patients (58.8%), and there was a tendency that the more severe papulopustular eruptions were, the more frequently xerosis occurred. Paronychia occurred in 8 patients (7.0%). CONCLUSION: Although the cutaneous adverse events are burdensome to the patients, they might serve as visible markers of the anti-tumor activity and therapeutic efficacy of cetuximab and they can be easily and safely controlled with many topical and systemic agents. Therefore, it is important for dermatologists to properly treat these cutaneous adverse events and to reassure the patient to continue with the cetuximab treatment.
Acneiform Eruptions ; Antibodies, Monoclonal, Humanized ; Benzoyl Peroxide ; Clindamycin ; Drug Therapy, Combination ; Hair ; Humans ; Medical Records ; Metronidazole ; Minocycline ; Mucositis ; Paronychia ; Receptor, Epidermal Growth Factor ; Retrospective Studies ; Tetracycline ; United States Food and Drug Administration ; Cetuximab

Although a basal cell carcinoma usually results from chronic irradiation of solar ultraviolet, some reports have mentioned that non-solar ultraviolet and trauma also could be etiologic factors of basal cell carcinoma. Herein, we report a case of a 64-year-old man who had worked as a welder for more than thirty years. Four years ago, he was burnt on his right upper eyelid during welding. After that, the lesion had been darkened and indurated, and finally was diagnosed as basal cell carcinoma. The significance of non-solar ultraviolet irradiation and thermal burn during welding in the pathogenesis of basal cell carcinoma is discussed.
Burns ; Carcinoma, Basal Cell ; Eyelids ; Humans ; Middle Aged ; Welding

Proliferative fasciitis is a rare, rapidly growing, pseudosarcomatous nodule of subcutaneous tissue. It commonly occurs on the extremities. Lesions on the head and neck are exceedingly rare. Histopathologically, it is characterized by several large basophilic ganglion-like cells deposited in a myxoid stroma with spindled cells. Herein, we report a case of a 54-year-old man who noticed a nodule on his right cheek about six months before examination. At first, its size abruptly increased, and then remained without any change in size. Microscopically, many basophilic ganglion-like cells and spindled cells were deposited in a myxoid stroma. Immunohistochemically, ganglion-like cells and spindled cells were strongly positive for vimentin and weakly positive for smooth muscle actin and CD68. Although it was not radically excised, the lesion has not been found for 3 months.
Actins ; Basophils ; Cheek ; Extremities ; Fasciitis ; Head ; Humans ; Middle Aged ; Muscle, Smooth ; Neck ; Subcutaneous Tissue ; Vimentin

Cutaneous metastasis from renal cell carcinoma is rare. Once metastatic cutaneous involvement of a renal cell carcinoma has occurred, the disease is already widespread and therefore has a very poor prognosis. Herein we report a case of a 59-year-old man who presented with a renal cell carcinoma metastatic to the scalp, lung, brain and contralateral kidney.
Brain ; Carcinoma, Renal Cell ; Humans ; Kidney ; Lung ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Scalp

PURPOSE: Endometriosis is the heterotropic occurrence of island of endometrial glands and stroma outside of uterus. It common occurs in pelvic cavity, but rarely at the ectopic area of extra-pelvic cavity. The aim of this study was to evaluate the clinical characteristics of extrapelvic endometriosis in order to help diagnosis and treatment. METHODS: Between January 2001 and June 2007, 22 patients who underwent surgery and was diagnosed as ectopic endometriosis of extra-pelvic cavity at Bundang CHA hospital were retrospectively reviewed with medical records and a telephone interview. RESULTS: All cases were women in their reproductive age, with a median age of 33 years (range 24~49 years). 17 of 22 cases were endometriosis in the scarring tissue of prior caesarean section wound on abdomen. 1 case in vaginal orifice on episiotomy wound of perineum, 1 case in femoral ring area and 3 cases in appendix. All patients except endometriosis of appendix, were presented with mass, pain and symptoms almost associated with menstruation. 18 of 22 cases were suspected of having extra-pelvic endometriosis due to their specific clinical features, 4 cases were suspected of hernia and acute appendicitis. All patients were treated with surgery. None has revisited to clinics due to recurrence. CONCLUSION: Women who have mass or lump in surgical scar and symptoms associated with menstruation period should be suspected of having endometriosis. Endometriosis of surgical scaring tissue should be treated by wide local excision to prevent local recurrence.
Abdomen ; Appendicitis ; Appendix ; Cesarean Section ; Cicatrix ; Endometriosis ; Episiotomy ; Female ; Hernia ; Humans ; Medical Records ; Menstruation ; Perineum ; Pregnancy ; Retrospective Studies ; Telephone ; Uterus