Chronic pancreatitis is a progressive disease without curative treatment. Abdominal pain is the most predominant symptom of chronic pancreatitis that initially brings most of the patients to the physician's attention. Some studies have correlated the course of pain in chronic pancreatitis in comparison with the duration of the disease, progressing exocrine and endocrine pancreatic insufficiency, and morphological changes such as pancreatic calcification and duct abnormalities. Furthermore, the course of pain has been studied after alcohol abstinence or surgery in some groups. However, there are only few well-performed and valid studies, and some of them even have produced diversing results, in part. Further controlled studies harvoring a large number of patients in a multicenter setting should be considered. Therapeutic efforts on chronic pancreatitis have focused on palliative treatment of pain which is present in about 80% of cases. Endoscopic treatment of pain in chronic pancreatitis is useful and feasible in many patients. Selecting candidate for endotherapy is mandatory. Main indication of pancreatic stent insertion in chronic pancreatitis is the presence of an obvious ductal stricture. Complications of chronic pancreatitis are also indications of endoscopic intervention. Exocrine and endocrine insufficiencies should be meticulously managed to prevent complications and to maintain good quality of life.
English Abstract ; Humans ; Pancreatitis, Chronic/*diagnosis/*therapy

This article explores the medical system of the Koryo Dynasty period and its social characteristics. First, the structure of medical system and roles of medical institutions during the Koryo Dynasty period will be summarized. Then, the characteristics of the medical system will be identified through exploring the principles of its formation in a view of social recognition of medical care and a view of public policy. During the Koryo Dynasty period, medical experts were trained in national education institutions from the early days of Dynasty. After trained, they were appointed to the posts at government service with their medical profession. In the meantime, they sought ways to ascend their social position. Physicians of Oriental medicine were appointed to the posts at each local government and troops to take charge of medical treatments of the common people. Also, the state tried to assume the reins of medical system by actively taking part in circulation (collection and distribution) of herb. Taeuigam and Sangyakguk represent central medical institutions of the Koryo, taking charge of medical service for the aristocracy and the bureaucracy. The Common people were treated at DongSeoDaeBiWOn, JeWuiBo, HyeMinGuk, and YakJum in SeoKyung. However, activities of these institutions became less active around the days of military officials regime, as officers became negligent and financial base went broken. The roles of medical institutions of the Koryo government were not restricted to the treatment of diseases. Policies for the common people were constituted by two main policies, the policy for encouraging agriculture and the policy for giving relief to people. Medical institutions, with other social systems, had a social responsibility to support the governing system of the Koryo and maintain the stability of the society. In this aspect, medical institutions such as DongSeoDaeBiWon and JeWuiBo, and relief institutions such as UiChang, were all related and connected organically, and they were results of, and bases of the relief policy. However, medical system for the common people was made up first for practical needs and then improved successively. Allocation of medical experts and execution of relief work were carried out by each local government, except the case of serious disaster, which central government took part in. As the Koryo Dynasty went into its latter period, temporary institutions and one - time benefits replaced permanent institutions. These four characteristics described above were systemic characteristics of medical system during the Koryo Dynasty period.
English Abstract ; History of Medicine, Medieval ; Korea ; *Medicine ; Political Systems/*history

Lack of historical records causes some difficulties in the historical studies of ancient Korea. It is the same case as that of the history of medicine. We imagine what the situation of medicine was like in ancient Korea with a bit of historical records. In ancient times, medicine had very close relation with religions. In ancient Korea, it had very close relation with Buddhism. According to {Sam Kuk Sa Ki and {Sam Kuk Yu Sa buddhists monks treated patients with the religious rituals. In this article, the authors would like to present a record which had been unnoticed until now. It is the commentary of Wonhyo on a certain Buddhistic cannon called {Kum Kwang Myung Kyung. A chapter of this cannon is on the theory of medicine, causes of diseases and treatments. We can presume Wonhyo's knowledge of medicine at that time through his commentary on this chapter.
Buddhism/*history ; English Abstract ; History of Medicine, Ancient ; Korea ; Religion and Medicine

This dissertation is concerned not with medical theories, but with practices of Greek physicians, and I have addressed the subject of medical ethics as related to the Hippocratic tradition. And I have attempted a synthetic account of Greek physicians' actual practice and its ideals in the Hippocratic tradition. My understanding of the tradition succeeds the revelations in the first chapter of my doctorial thesis, one of them is the fact that Hippocratic tradition is amalgamation of ethical code with rational or scientific medical theory. In the first chapter of this dissertation, I have attempted a social history of Greek physicians by analyzing Hippocratic writings. The Hippocratic collections, Corpus Hippocraticum, throw light not only on the origins and early development of classical medicine, but on its place in Greek Society. In the second chapter, I aim at understanding of the medical morality in its practice by analyzing the Corpus. Particularly the Oath shall be examined. Some questions, above all, such as "Was it ever a reality or merely a 'counsel of perfection'?" can not be answered. But by the way of the examination of the deontological treatises, the characters of the ethics of Greek physicians become clear. It was the result of outward performance in the relation of inner intention. In the result Greek physicians were the first to attempt to establish a code of behaviour for the medical profession and to define the doctor's obligations to the society.
English Abstract ; Ethics, Medical/*history ; Greece ; History of Medicine, Ancient

Stem cells are undifferentiated cells capable of undergoing self-renewal and differentiation into a variety of cell types. They are derived from adult tissues (adult stem cells) as well as embryonal blastocysts (embryonic stem cells). Embryonic stem cells have pleuripotent capacity able to form tissues of all three germ layers but many ethical controversies concerning resource allocation or methods of harvesting are arising. Recently, many studies have demonstrated the multipotency of adult stem cells, but the mechanism of the plasticity remains to be determined yet. Several studies have suggested the possibilities of application of stem cells or tissue specific cells to regenerate gastroenterologic diseases such as liver cirrhosis, hepatitis, or inherited metabolic disorders. However, most of those trials are still limited to animal models, although anecdotal claims of successful therapy in humans have been reported. Even though the expectations and the promise of cell therapy are high, clinical efficacy has not been definitely demonstrated at this time. Thus, the application of cell therapy cannot be recommended to the patients outside the clinical trial setting.
English Abstract ; Gastrointestinal Diseases/*surgery ; Humans ; *Stem Cell Transplantation

In Taegu, the Yaknyongshi was established as early as the 9th year of King Hyojong(1658) of the Chosen Dynasty, and in the 10th year of King Hyojong(1659) the 'Tonguibogam' was published as a Yongyongbon edition by the Kyongsang Provincial Government In fact, it may not be an exaggeration to say that Taegu was the base of the traditional medicine in Korea. In the meantime the general public began to become aware of the importance of Western medicine when Dr. Woodbridge O Johnson of the Northern Presbyterian Church introduced Western medicine by opening the 'Miguk Yakpang'(American dispensary) and began to teach Western medicine to Korean youths. At that time, while constructing the Kyong for a war against Russia, Japanese began to establish hospitals in several major cities and towns along the railway line and mobilized Tonginhae doctors. However, those medical facilities were solely for the benefit of Japanese people residing in Korea and had nothing to do with ordinary Koreans. The attached medical school of the Taegu Tonginuiwon failed, contrary to expectation, to turn out even a single Korean medical doctor. This hospital was later reorganized into Taegu Chahyeuiwon and was soon closed according to the policy of educational unification of the Government General Korea. The keen interest in the Western medicine shown by the people of Taegu resulted from the long history of this area as a base of Oriental medicine. More than 10 years after the abolition of the institute far Western medicine in Pyongyang a Western medical training center was inaugurated as a night school in January 1923 by the Chahyeuiwon and the school began to be operated under the name of the Pyongyang Provincial Medical Training Institute. In July 1923, in Taegu, the Taegu Medical Training Institute was inaugurated in the compound of the Chahyeuiwon as a night school in imitation of the institute in Pyongyang. In march 1924, this institute, following the example of that in Pyongyang was renamed the Taegu Provincial Medical Training Institute with the promulgation of a decree of Kyongsangbukdo regarding the regulation on the Taegu Medical Training Institute. Thanks to the strong demand by the population of the Kyongsanbukdo, fund-raising and other campaigns by Koreans and Japanese, and active efforts by the local governmental authorities, the Taegu Provincial Medical Training Institute was approved as an institute of a semimedical college level by the Government-General in Korea with the promulgation of the regulations on the Kyongsangbuk-do Medical Training Institute in May 1929. In March 1930, both the Taegu Provincial Medical Training Institute and Pyongyang Provincial Medical Training Institute were designated as "Uihakkyo(medical school)" by the Government-General in Korea. By this designation, the graduates of the schools were given a medical license permitting them to practice medicine in korea. That is to say, the graduates enjoyed the same privilege to exercise professional right within Korea as those of other medical colleges. Three years later, on March 4 1933, the regulations on public schools in Korea were revised and, on March 6, the establishment of medical colleges were permitted. Thus, in Kyongsangbukdo, the regulations on the Taegu Medical College were proclaimed in the form of a decree of the provincial government and, in accordance with the regulations, professors were nominated and students were recruited. In the meantime, with the timely completion of construction of the college building in August 1933, the college moved to the new compound in November of the same year. Thus, the Taegu Medical College, equipped with new facilities, emerged and satisfied the long-cherished desire of the people in this area. Unlike the Pyongyang Medical College, the Taegu Medical College had some Korean teaching staff members. They were: Pak Jae-Hwan(professor) ; Seo Sung-Hae, Chung He-Taek, Lee Myeng-Hun, Kwon Kil-Chae, Choe Duk-Saeng, Pae Chong-Ho, Lee Chil-Hui(assistant professor) ; and Cha Ham-Su, Kee Yong-Suk(instructors). They taught and conducted research in various departments of clinical and basic medicine. However, there were few Korean graduates of the Taegu Medical College who continued study and research at their alma mater. It is known that Korean graduates of this medical college did their study and research mostly at medical colleges in Japan or at the Medical Department of the Kyongsuong Imperial University. The author wishes to pay his tribute of sincere praise to the painstaking efforts and diligence of the small number of graduates of this medical college who, in spite of the haughtiness and prejudice by the Japanese, conducted study and research that later led to the foundation of the Kyongbuk University Medical College.
Education, Medical/*history ; English Abstract ; History of Medicine, 20th Cent. ; Korea

Medical management of acute pancreatitis relies on supportive care such as fluid resuscitation and pain control. Prophylactic antibiotics can reduce the opportunity of infection in severe pancreatitis. The effect of somatostatin or protease inhibitors still needs to be evaluated through further study. Early endoscopic retrograde cholangiopancreatography (ERCP) can ameliorate the course of severe biliary pancreatitis. Although sterile pancreatic necrosis, acute fluid collection, and pseudocyst usually resolve spontaneously, endoscopic or percutaneous drainages are needed when these complications are infected.
Acute Disease ; English Abstract ; Humans ; Pancreatitis/complications/*therapy

Acute pancreatitis is an inflammatory disease of pancreas which come from various etiologies. The pathologic spectrum of acute pancreatitis varies from mild edematous pancreatitis to severe necrotizing pancreatitis. To diagnose and to predict severity in acute pancreatitis, various biochemical marker, imaging modalities and clinical scoring sytstem are needed. Ideal parameters should be accurate, be performed easily and enable earlier assess. Unfortunately, no ideal parameter is available up to date. Serum amylase and lipase are still useful for the diagnosis but meaningless in predicting severity. C-reactive protein and inflammatory cytokines are promising single parameters to predict the severity. CT finding is also an useful determinant of severity, but is expensive and is delayed in assessment.
Acute Disease ; English Abstract ; Humans ; Pancreatitis/*diagnosis ; Severity of Illness Index

Despite the small size of its genome (3.2 kb) and having only four genes that are encoded within it, the hepatitis B virus (HBV) is one of the most successful viral pathogens in human history. It is estimated that there are about 350-400 million people worldwide who are chronically infected with HBV, and even with the extensive efforts that are being done with preventive vaccination, this malady still remains a clear and present danger to the public health. How is it possible that this small double-stranded DNA virus can escape and outfox the surveillance of the complex human immune system? One explanation is that HBV gene products play multiple roles in infections and throughout the viral life cycle so that the virus can effectively survive under various hostile circumstances. Indeed, the HBV DNA polymerase, for example, exerts several functions such as reverse transcription and RNA degradation, and the HBV X protein not only acts as a transcriptional activator, but it also interferes with the host cells' DNA repair mechanism as well as inducing apoptosis and controlling signal transduction. The HBV surface protein, which is encoded in the env gene, is another intriguing example of such multifunctionality. Thus, our present article overviews and summarizes the multifaceted role of this membrane protein as shown in 1) its role as a structural protein of the virus envelope; 2) its function as the viral ligand for interacting with the viral receptors on host cells; 3) its characteristics as an energy-independent transporter molecule that can mediate the nuclear accumulation of itself and other tagged molecules; 4) its role as a viral transactivator protein that can cause hepatocellular carcinoma; 5) its hypothetical function in viral apoptotic mimicry that results in host anti-inflammatory responses; and last 6) its immunostimulatory property by providing for strong and well-defined B- and T-cell epitopes. Understanding these various functions and the versatility of this single protein will help us decipher and understand the viral- and immuno-pathogenesis of HBV itself.
Animals ; English Abstract ; Hepatitis B Surface Antigens/*physiology ; Humans

Orthotopic liver transplantation (OLT) is now considered as a standard procedure for patients with end-stage liver disease. The number of patients listed for OLT using the brain-dead donor continues to outpace the number of OLT performed since early 1990s because the improved results of OLT had made it as a therapeutic means for irreversible liver disease. This scarcity of organs from the deceased donors has resulted in the increased use of the living donor liver grafts. Although the shortage of the brain-dead donor organs is a world-wide problem, the situation is especially serious in our country, where the deceased donor organ donation remains below 2 per million population per year. Now, Korea has the greatest need for living donor liver transplantation although it is more complex and demanding procedure than the deceased donor (whole organ) liver transplantation. Refinements of the technique and good results have rapidly established the position of the living donor liver transplantation in our country's transplant medicine. 2,345 OLTs (1,860 from the living donor and 485 from the deceased donor) were performed in 24 institutes from March 1988 to December 2004, although 5 institutes had performed more than 10 OLTs per year. Definitely, living donors represent a large pool of organs, but there might be a significant cost, mainly donor risk, to draw from this pool. To alleviate some disadvantages of the living donor liver transplantation and to provide organ to the patients who cannot find out the potential living donor from family members, recognition of necessity and nation-wide cooperative participation of organ donation after the brain-death should be propagated and encouraged in our country.
English Abstract ; Humans ; Korea ; *Liver Transplantation/contraindications ; Living Donors