The Korean Society of Gastrointestinal Endoscopy (KSGE) developed regulations and a gastrointestinal endoscopy board in 1995. Although the KSGE has acquired many specialists since then, the education and training aims and guidelines were insufficient. Although endoscopic examinations are supervised by a specialist during a GI fellowship, some types of GI endoscopic examinations and treatments are difficult to obtain exposure. Fellows should acquire endoscopic skills through repeated independent endoscopic examinations after a GI fellowship. Thus, the KSGE requires training guidelines for fellowships that allow fellows to perform endoscopic examinations without a supervisor. This document is intended to provide the principles that the Committee of Education and Training of KSGE can use to develop practical guidelines for granting privileges to perform accurate GI endoscopy safely. KSGE will contribute to improving the quality of GI endoscopy by providing guidelines for fellowships and supervisors.
Endoscopy ; Endoscopy, Gastrointestinal ; Fellowships and Scholarships ; Financing, Organized ; Social Control, Formal ; Specialization

Neurofibromatosis(NF) is a heterogeneous disorder clinically characterized by the presence of neurofibromas, multiple caf au lait spots, intertriginous freckles and Lisch nodules. It is usually expressed as a generalized form, but is rarely localized in a limited part of the body as a segmental form. In 1982, Riccardi classified NF into 8 types and in a segmental NF(type V) the cutaneous lesions are limited to a single body segment, often in a unilateral, dermatomal disposition. We report a 45-year-old Korean woman who presented with several grouped soft, fresh red colored papules and nodules on the left side of the neck(left C2, C3 dermatomes). There were no caf -au-lait spots, axillary freckles, Lisch nodules or family history. A biopsy specimen of cutaneou nodules showed circumscribed non-encapsulated tumor of the dermis was composed of loosely spaced spindle cells with elongated, wavy nuclei and thin, wavy collagenous strands. On the basis of clinicopathologic examination we diagnosed as segmental NF.
Biopsy ; Collagen ; Dermis ; Female ; Humans ; Melanosis ; Middle Aged ; Neurofibromatoses*

Pemphigus foliaceus is a rare, relatively mild and chronic variety of pemphigus which is characterized by superficial flaccid bullae which show acantholytic changes in the upper part of the epidermis histopathologically. Present case is a 40-year-old female with a 2 month history of yellowish colored verrucous plaques on the whole scalp. 6 years ago, she had been admitted to our hospital because of nearly generalized erythematous eroded patches, crusted plaques and bullae and diagnosed as pemphigus foliaceus and treated with corticosteroid and methotrexate. 2 months ago, an additional lesion was found on the scalp, where yellowish colored, verrucous surfaced plaques were observed. Histologic examination on the verrucous plaque showed hyperkeratosis, acanthosis and papillomatosis with acantholysis in the granular layer, leading to a subcorneal blister and dyskeratotic granular keratinocytes were seen within the blister. On the basis of clinicopathologic examination we diagnosed as pemphigus foliaceus and then we treated her with prednisolone and the skin lesion had subsided 7 months later. We report a patient of pemphigus foliaceus who was presented with verrucous surfaced plaque, which clinically mimicked pemphigus vegetans.
Acantholysis ; Adult ; Blister ; Cytochrome P-450 CYP1A1 ; Epidermis ; Female ; Humans ; Keratinocytes ; Methotrexate ; Papilloma ; Pemphigus* ; Prednisolone ; Scalp ; Skin

A 46-year-old male patient had recurrent episodes of generalized pruritic wheals during hemodialysis. He has experienced urticaria during hemodialysis whenever he used a capillary dialyser sterilized by ethylene oxide(EO, Polysulfone-) gas which is used to sterilize hemodialysers and other medical equipment. On the other hand, capillary dialyser sterilized by Gamma ray (Hemophad) has not evoked urticaria. Although the presence of EO-specific antibodies was not detected, urticarial rash never developed when the equipment was switched to a gamma-sterilized one. We herein report a case referred to ethylene oxide induced cutaneous hypersensitivity during hemodialysis.
Antibodies ; Capillaries ; Ethylene Oxide ; Exanthema ; Gamma Rays ; Hand ; Humans ; Hypersensitivity* ; Kidneys, Artificial ; Male ; Middle Aged ; Renal Dialysis* ; Urticaria

Hereditary hemorrhagic telangiectasia, also known as Osler-Rendu-Weber disease, is an autosomal dominant hereditary disorder leading to easily bleeding telangiectases on skin and mucosal surfaces, and it is associated with the presence of arteriovenous malformations in multiple organ systems. It is usually recognized as classic triad of telangiectasia, recurrent epistaxis and a family history of the disorder. We report herein a case of hereditary hemorrhagic telangiectasia in a 12-year-old male who had episodes of recurrent epistaxis and compatible telangiectatic skin lesion. And his grandfather, father, uncle and cousin also had similar punctiform, linear and spider-like telangiectatic lesions.
Arteriovenous Malformations ; Child ; Epistaxis ; Fathers ; Hemorrhage ; Humans ; Male ; Skin ; Telangiectasia, Hereditary Hemorrhagic* ; Telangiectasis

A 7-year-old female was presentd with two black papules and linear pigmentation between papules on the vulva. No other abnormalities were found in her personal and family history. Histopathological examination was consistent with the apocrine hidrocystoma and the pigment in the luminal cells was iron negative and Fontana Masson positive, confirming its melanin nature. We herein report a 7-year-old female patient with pigmented apocrine hidrocystoma occuring on the vulva with the evidence of melanin as the underlying mechanism of the pigmentation.
Child ; Female ; Hidrocystoma* ; Humans ; Iron ; Melanins ; Phenobarbital ; Pigmentation ; Vulva*

Malignant melanomas are common metastatic lesions in the gastrointestinal tract. There are some descriptions for endoscopic findings but few reports on the endoscopic ultrasonographic findings of metastatic malignant melanomas in the stomach. A 67-year-old woman was admitted due to indigestion persisting for 1 month. She had a 3x4 cm sized black pigmented skin lesion on her left foot. An abdominal ultrasonography and CT scan revealed multiple variable sized round lesions in the liver, suggesting metastatic lesions. An endoscopy revealed multiple, elevated lesions with central ulcerations and a star shaped black pigmentation around the ulcer mound on the antrum of the stomach, as well as huge ulcers with black pigmented bases on the upper body. An endoscopic ultrasonography determined that the depths of the elevated lesions on the antrum were 1imited to the mucosal layer and that huge ulcers on the upper body were invading the serosa simultaneously. The skin lesion was diagnosed as a malignant melanoma and the stomach lesion were also confirmed to be metastatic malignant melanomas. The case of malignant melanomas that metastased to the stomach and had unusual endoscopic ultrasonographic findings is herein reported.
Aged ; Dyspepsia ; Endoscopy ; Endosonography ; Female ; Foot ; Gastrointestinal Tract ; Humans ; Liver ; Melanoma* ; Neoplasm Metastasis ; Pigmentation ; Serous Membrane ; Skin ; Stomach* ; Tomography, X-Ray Computed ; Ulcer ; Ultrasonography

Stenosing papillitis is a descriptive term for an anatomic deformity of the Ampulla of Vater due to chronic inflammation and fibrosis, which is characterized by narrowing of the lower end of the bile and pancreatic duct, and by clinical symptoms resembling pancreticobiliary disease. Duodenoscopic finding of "stenosing papillitis" usually shows edema, erythema, and laceration on Ampulla of Vater, but endoscopic finding such as polypoid mass is rare. We recently experienced one case of polypoid stenosing papillitis and report with a review of relevant literatures A 54-year-old man was admitted to our hospital because of chronic right upper abdominal pain for 2 years. Duodenoscopy re-vealed a polypoid mass with erythemaous color change on Ampulla of Vater, which was endoscopically resected by using a polypectomy snare, and pathologic examination showed chronic inflammation and fibrosis.
Abdominal Pain ; Ampulla of Vater* ; Bile ; Congenital Abnormalities ; Duodenoscopy ; Edema ; Erythema ; Fibrosis ; Humans ; Inflammation ; Lacerations ; Middle Aged ; Pancreatic Ducts ; Papilledema* ; SNARE Proteins

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.
Absorption ; Biological Availability ; Fasting ; Gastric Acid ; Hospitals, General ; Humans ; Itraconazole* ; Korea ; Outpatients ; Tablets ; Tinea Pedis* ; Tinea* ; Treatment Failure

PURPOSE: The purpose of this paper was to evaluate the treatment results according to bone union, union time, and complications, including infection of unreamed nailing of tibial fractures between closed and open fractures. MATERIALS AND METHODS: We reviewed 64 tibial shaft fractures that were treated with unreamed tibial nail. These included 42 closed fractures and 22 open fractures. RESULTS: Average union time of closed fractures was 19.8 weeks and that of open fractures was 20.2 weeks, nonunion rate were 4/42 and 3/22 in closed and open fractures. Average union time were 19.2, 20.4, 21.3 weeks in open grade I, II, llla fractures. According to the type of fractures, average union time were 18.5, 20.2, 24.6 weeks and nonunion rate were 2/29, 3/26, 2/9 in type A, B, C fractures. According to the level of fractures, average union time were 20.0, 20.3, 19.4 weeks and nonunion rate were 1/5, 4/37, 2/22 in proximal, middle, and distal fractures. There was no significant differences in average period of radiologic union, infection rate and nonunion rate between closed and open fracture group, but longer union time and higher nonunion rate in complex and comminuted fractures (P<0.05). CONCLUSIONS: We consider unreamed intramedullary nailing in the tibial shaft fractures as a good treatment modality for closed and open grade I, II, IIIa fractures
Fracture Fixation, Intramedullary ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Tibial Fractures*