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.

Eosinophilic granulomatosis with polyangiitis (EGPA), previously called Churg-Strauss syndrome, is an anti-neutrophil cytoplasmic antibody associated vasculitis, accompanied by asthma, hypereosinophilia, nonfixed pulmonary infiltrates, and sinusitis. Peripheral neuropathy is common in patients with EGPA; however, a few cases of EGPA with central nervous system (CNS) involvement have been reported. A 45-year-old female referred for right side weakness and posterior neck pain was diagnosed as EGPA with subarachnoid hemorrhage and mononeuritis multiplex. She was effectively treated with a high dose glucocorticoid, cyclophosphamide, and intravenous immunoglobulin. EGPA with CNS involvement is uncommon and causes significant morbidity and mortality. Therefore more rapid and accurate diagnostic evaluation may be required. EGPA should be considered in patients with neurological symptoms and hypereosinophilia.
Antibodies, Antineutrophil Cytoplasmic ; Asthma ; Central Nervous System ; Churg-Strauss Syndrome ; Cyclophosphamide ; Eosinophils* ; Female ; Humans ; Immunoglobulins ; Middle Aged ; Mononeuropathies* ; Mortality ; Neck Pain ; Peripheral Nervous System Diseases ; Sinusitis ; Subarachnoid Hemorrhage* ; Vasculitis

PURPOSE: Headache patients with an alert mental state and normal neurologic examination findings who visit the emergency department (ED) should be differentially diagnosed for the presence of cerebral vessel disease. Hence, the purpose of this study was to analyze the abnormal three-dimensional cerebral computed tomographic angiography (3D-CTA) findings of mentally alert patients presenting headache, and investigate the clinical factors predictive of an intracranial abnormality. METHODS: A total of 227 patients visiting the ED presenting headache and possessing an alert mental status were enrolled in this study and examined by 3D-CTA from January 2008 to December 2008. We compared the results of the 3D-CTA and the final clinical diagnosis for each patient. The patient participants were divided into two groups: an abnormal group, as confirmed by 3D-CTA, and a non-abnormal group. We compared the vital signs, past hypertension history, clinical manifestations, and the clinical factors predictive of abnormality between the two groups. RESULTS: Of the total patients, 44 were identified with abnormal findings by non-enhanced CT, and 61 patients were identified with abnormal findings by 3D-CTA. SAH was found in 29 patients and unruptured aneurysm was discovered in 17 patients using 3D-CTA. The time interval between onset of headache to arrival at the ED was shorter in the SAH group (p=0.012), and sudden bursting headache was observed in 22 subarachnoid hemorrhage (SAH) patients (p<0.001). Statistically significant differences were observed between the two groups for symptoms of nausea, vomiting, neck stiffness and seizure. According to the results of the multivariate logistic regression analysis, sudden bursting headache and neck stiffness were independent predictable variables that affected the abnormal 3D-CTA group. According to the results of the multivariate logistic regression analysis, sudden bursting headache and neck stiffness were independent predictable variables for the abnormal 3D-CTA group. CONCLUSION: Sudden bursting headache, neck stiffness, vomiting, and advanced age were independent predictable variables observed in the abnormal 3D-CTA group.
Aneurysm ; Angiography ; Emergencies ; Glycosaminoglycans ; Headache ; Humans ; Hypertension ; Logistic Models ; Nausea ; Neck ; Neurologic Examination ; Seizures ; Subarachnoid Hemorrhage ; Vital Signs ; Vomiting

PURPOSE: Headache patients with an alert mental state and normal neurologic examination findings who visit the emergency department (ED) should be differentially diagnosed for the presence of cerebral vessel disease. Hence, the purpose of this study was to analyze the abnormal three-dimensional cerebral computed tomographic angiography (3D-CTA) findings of mentally alert patients presenting headache, and investigate the clinical factors predictive of an intracranial abnormality. METHODS: A total of 227 patients visiting the ED presenting headache and possessing an alert mental status were enrolled in this study and examined by 3D-CTA from January 2008 to December 2008. We compared the results of the 3D-CTA and the final clinical diagnosis for each patient. The patient participants were divided into two groups: an abnormal group, as confirmed by 3D-CTA, and a non-abnormal group. We compared the vital signs, past hypertension history, clinical manifestations, and the clinical factors predictive of abnormality between the two groups. RESULTS: Of the total patients, 44 were identified with abnormal findings by non-enhanced CT, and 61 patients were identified with abnormal findings by 3D-CTA. SAH was found in 29 patients and unruptured aneurysm was discovered in 17 patients using 3D-CTA. The time interval between onset of headache to arrival at the ED was shorter in the SAH group (p=0.012), and sudden bursting headache was observed in 22 subarachnoid hemorrhage (SAH) patients (p<0.001). Statistically significant differences were observed between the two groups for symptoms of nausea, vomiting, neck stiffness and seizure. According to the results of the multivariate logistic regression analysis, sudden bursting headache and neck stiffness were independent predictable variables that affected the abnormal 3D-CTA group. According to the results of the multivariate logistic regression analysis, sudden bursting headache and neck stiffness were independent predictable variables for the abnormal 3D-CTA group. CONCLUSION: Sudden bursting headache, neck stiffness, vomiting, and advanced age were independent predictable variables observed in the abnormal 3D-CTA group.
Aneurysm ; Angiography ; Emergencies ; Glycosaminoglycans ; Headache ; Humans ; Hypertension ; Logistic Models ; Nausea ; Neck ; Neurologic Examination ; Seizures ; Subarachnoid Hemorrhage ; Vital Signs ; Vomiting

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

BACKGROUND: This study was conducted to compare two models of the pediatric logistic organ dysfunction (PELOD) score and the pediatric index of mortality (PIM) 2 score in the emergency department (ED) and intensive care unit (ICU). METHODS: 90 pediatric patients who were admitted to the ICU in ED from January 2003 to December 2008 were enrolled in this study. PELOD score and PIM 2 score calculations were performed in the ED and ICU. We classified these patients into either the survivor or non-survivor groups and analyzed the clinical variables between two groups. We used Hosmer-Lemeshow goodness-of-fit tests to evaluate calibration, receiver operating characteristic (ROC) curves and standardized mortality ratio (SMR). RESULTS: Among the 90 pediatric patients, 56 (62.2%) were male, and 9 (10.0%) patients died. Expected mortalities were PIM 2 = 10.35, PELOD = 8.33 in ED and PIM 2 = 8.84, PELOD = 8.26 in ICU. PIM 2 showed fit calibration (x(2) = 6.228, p = 0.622) in the ED. In the ICU, both PELOD and PIM 2 showed calibration (x(2) = 4.625, p = 0.185) and (x(2) = 7.616, p = 0.472), respectively. PIM 2 in ED showed the best discrimination, with area under the curve (AUC) = 0.949 (95% CI, 0.881-0.984). CONCLUSIONS: PIM 2 score in ED was fit. Also, PELOD and PIM 2 score in ICU was fit. But PELOD in ED was unfit.
Calibration ; Discrimination (Psychology) ; Emergencies ; Humans ; Critical Care ; Intensive Care Units ; Male ; Pediatrics ; Prognosis ; ROC Curve ; Survivors

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

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

PURPOSE: This study was conducted to see the effect of alcohol ingestion on clinical features of acute drug intoxicated patients. METHODS: We prospectively investigated drug intoxicated patients who visited the emergency department 6 hours after acute poisoning from January 2004 to December 2007. Patients were classified into two groups according to serum alcohol levels: an alcohol group (serum alcohol level>10 mg/dl) and a non-alcohol group. The type of toxic material, age, sex, duration of time to arrive to the emergency department (ED) after poisoning, mean arterial pressure, respiratory rate, base excess level, AST level, serum creatinine level, cause of poisoning, suicide attempt, past psychiatric history, discharge against medical advice rate, and admission rate were checked. The initial and final Poisoning Severity Score (PSS), the Glasgow coma scale, the length of stay in the intensive care unit (ICU), the usage of a mechanical ventilator, and death rate were also checked. RESULTS: The study enrolled 222 intoxicated patients of which 75 fell into the non-alcohol group and 147 into the alcohol group. Alcohol ingestion of acute poisoning in males was higher than in females. The AST level and discharge against medical advice rates in the alcohol group were higher than the non-alcohol group. The base excess level, length of stay in ICU, past psychiatric history rate, and admission rates in the non-alcohol group were higher than the alcohol group. The PSS were not correlated with alcohol consumption between the two groups. CONCLUSION: Alcohol ingestion is not associated with PSS. However, alcohol ingestion is commonly found in acute drug intoxicated patients. The discharge against medical advice rate in the alcohol group was higher than the non-alcohol group.
Alcohol Drinking ; Arterial Pressure ; Creatinine ; Eating ; Emergencies ; Female ; Glasgow Coma Scale ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Prospective Studies ; Respiratory Rate ; Severity of Illness Index ; Suicide ; Ventilators, Mechanical

BACKGROUND: Incidents of suicide attempts and acute poisonings in the elderly population is rising. This study com- pared elderly and younger patients to investigate the influence of age on the clinical nature of acute poisoning. METHODS: We retrospectively investigated 147 patients with acute poisoning who visited the emergency department within 6 hours of exposure. Patients were divided into two groups, young adult(20-40 yrs) and elderly(> or =55 yrs). Information on type of toxic material, age, sex, duration of time to arrive to the emergency department(ED) after poisoning, cause of poisoning, usage of activated charcoal and gastric lavage, previous suicide attempts, and past psy- chiatric history were collected. And, the mean arterial pressure, respiratory rate, base excess, aspartate aminotransfe- rase(AST), serum creatinine, rate of discharge against medical advice, intensive care unit(ICU) admission rate, discharge rate, duration in ICU, usage of mechanical ventilator, and death rate were analyzed. Initial and final Poisoning Severity Scores(PSS) of each patient were calculated. RESULTS: The mean age of the young adult group and the elderly group were 30.6+/-6.1 yrs and 66.6+/-8.2 yrs, respectively. Cause of poisoning was accidental more often in the elderly group than in the young adult group. AST and creatinine levels were higher and base excess was lower in the elderly group. ICU admission rate, duration in ICU, usage of mechanical ventilator, death rate, and initial and final PSS were all higher in the elderly group as well. CONCLUSION: This study showed that the PSS and death rate from acute poisoning were higher in the elderly group than in the young adult group.
Aged ; Arterial Pressure ; Aspartic Acid ; Charcoal ; Creatinine ; Emergencies ; Gastric Lavage ; Humans ; Critical Care ; Respiratory Rate ; Retrospective Studies ; Suicide ; Ventilators, Mechanical ; Young Adult