Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians

Gastrointestinal endoscopy plays an important diagnostic and therapeutic role in the field of gastrointestinal disease. As endoscopies have become more common due to the nationwide screening program for digestive cancer and an increasing interest in health among the general public, the risk of infection transmission between patients has emerged as a clinical challenge. Although endoscopes can become highly contaminated with secretions and blood during use, the thorough reprocessing of an endoscope before it is reused in subsequent patients can be difficult due to its complicated structure. Although the incidence of endoscopy-associated infections has been reported to be extremely low, compelling evidence suggests that the actual incidence is underestimated. It has been well established that endoscopes reprocessed appropriately, in accordance with standard guidelines, have no risk of infection transmission. Although revised guidelines for endoscope reprocessing were released in Korea in 2015, suboptimal infection prevention practices during endoscope reprocessing have been reported. Under these circumstances, the Korean Society of Digestive Endoscopy developed the ‘Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians’ based on the currently available evidence. These guidelines provide accurate and updated information on reprocessing techniques, and can help improve the quality of reprocessing and compliance by health care personnel. As a result, infection control during gastrointestinal endoscopies can be expected to be achieved in Korea.

Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians

Gastrointestinal endoscopy plays an important diagnostic and therapeutic role in the field of gastrointestinal disease. As endoscopies have become more common due to the nationwide screening program for digestive cancer and an increasing interest in health among the general public, the risk of infection transmission between patients has emerged as a clinical challenge. Although endoscopes can become highly contaminated with secretions and blood during use, the thorough reprocessing of an endoscope before it is reused in subsequent patients can be difficult due to its complicated structure. Although the incidence of endoscopy-associated infections has been reported to be extremely low, compelling evidence suggests that the actual incidence is underestimated. It has been well established that endoscopes reprocessed appropriately, in accordance with standard guidelines, have no risk of infection transmission. Although revised guidelines for endoscope reprocessing were released in Korea in 2015, suboptimal infection prevention practices during endoscope reprocessing have been reported. Under these circumstances, the Korean Society of Digestive Endoscopy developed the ‘Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians’ based on the currently available evidence. These guidelines provide accurate and updated information on reprocessing techniques, and can help improve the quality of reprocessing and compliance by health care personnel. As a result, infection control during gastrointestinal endoscopies can be expected to be achieved in Korea.

A Case of Groove Pancreatitis with a Characteristic Pathologic Feature / 대한소화기학회지

Groove pancreatitis is a rare form of chronic pancreatitis in which scarring is found mainly in the groove between the head of the pancreas, duodenum, and common bile duct. The pathogenesis of groove pancreatitis is still unclear but seems to be caused by the disturbance of pancreatic outflow through Santorini duct. It is often difficult to differentiate preoperatively between groove pancreatitis and pancreatic head carcinoma. Whereas conservative management is effective, some patients with duodenal obstruction may undergo Whipple's operation. A few case of groove pancreatitis have been reported in Korea, and they were diagnosed only by clinical and radiological features. We experienced a case of groove pancreatitis who needed a surgical management because of severe duodenal obstruction. We report the case with a review of its characteristic pathologic findings.

An Adult with Aplastic Crisis induced by Human Parvovirus B19 as an Initial Presentation of Hereditary Spherocytosis

The association between aplastic crisis and human parvovirus (HPV) B19 infection is well described in patients with sickle cell anemia. This association has also been described, although much less frequently, in patients with hereditary spherocytosis (HS). However, most cases of aplastic crises in patients with HS and induced by HPV B19 have been reported in children or adolescents. In this paper, we describe an aplastic crisis induced by HPV B19 in an adult with HS. A 34-year-old female presented with presyncope, febrile sensation, and myalgia. The complete blood counts showed severe anemia. The peripheral blood smear revealed spherocytosis with reticulocytopenia and pancytopenia. The direct Coombs' test was negative; the osmotic fragility test was positive. In the bone marrow aspirates, a few giant pronormoblasts with deep blue cytoplasm, pseudopods, and intracellular inclusion bodies were observed. The patient was given eight units of packed red blood cells. HPV B19 infection was proven by the presence of IgM antibodies to HPV B19 and the detection of viral DNA using the PCR technique. To the best of our knowledge, this is the first report in Korea that describes an adult with aplastic crisis presenting initially with HS.

Porphyria Cutanea Tarda Presenting as Jaundice / 대한간학회지

Porphyria cutanea tarda (PCT) is a disease characterized by an early appearance of severe photosensitivity with an increase in urinary uroporphyrin excretion and other porphyrins, high isocoproporphyrin fecal levels and an accumulation of protoporphyrin in erythrocyte. This disease has been known to be caused by a dramatic decrease in the activity of the uroporphyrinogen decarboxylase. Multiple infectious and environmental factors may contribute to PCT by influencing oxidative stress in the hepatocytes. We report here on a case of porphyria cutanea tarda that presented with jaundice and photosensitivity.

A Case of Rapidly Progressive Glomerulonephritis Associated with Hepatitis C Virus / 대한신장학회잡지

Chronic HCV infection has been reported to be associated with several extrahepatic conditions such as cryoglobulinemia, lymphoma, lichen planus, porphyria cutanea tarda, autoimmune thyroiditis, and renal disease. Glomerular disease may occur in patients with chronic HCV infection. The most common patterns are membranoproliferative glomerulonephritis, and less frequently, membranous nephropathy, fibrillary glomerulonephritis and immunotactoid glomerulopathy. Few crescentic glomerulonephritis has been reported in association with HCV infection, and no case was reported in Korea yet. We experienced one case of rapidly progressive glomeruloinephritis with the pathology of crescentic glomerulonephritis complicated in membranoproliferative glomerulonephritis in a patient with HCV infection.

Left Pulmonary Artery Agenesis Accompanied with Fistula of Left Circumplex Artery to Left Bronchial Artery

Left pulmonary artery agenesis, accompanied by a coronary arterial fistula, is a very rare anomaly. Although unilateral pulmonary artery agenesis is associated with other cardiovascular defects, like as ventricular septal defect, patent ductus arteriosus, and tetralogy of fallot, this anomaly, accompanied by a coronary arterial fistula, has not yet been reported. Most patients with no associated cardiac anomalies have only minor, or absent, symptoms, and survive to adulthood, but some patients may suffer from recurrent respiratory infections and hemoptysis. The vessel to the affected lung in many of the proved cases has been described as arising from either the bronchial artery or the aortic arch. The blood supply from the coronary artery to the affected lung has never been reported. Recently, a case of left pulmonary artery agenesis, accompanied with a coronary arterial fistula was experienced, which was diagnosed by coronary angiography and a chest CT, which is presented, with the review of relevant literature.