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

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

Medical license is to qualify a person for medical practice and to attribute him/her a privileged right in the practice. This privileged and exclusive right asks for protection from the side of a state and the state in turn needs qualified medical personnel in order to carry out her task of public health, one of the main duties of modern states. In Europe, physicians succeeded in obtaining medical license that guarantees the privileged right in a highly competitive medical market against other practitioners. The first regulation for medical license in Korea was made in 1900 when few Korean doctors trained in Western medicine was in practice. The regulation aimed at controlling traditional medical practitioners who had been practicing medicine without any qualification as a physician. The regulation was very brief, consisting of only seven articles. A newly revised regulation appeared in 1913 when Korea was under the occupation of Japan. The Japanese Government-General enacted a series of regulations about medical personnel, including dentists and traditional medical practitioners. This heralds its full-scale engagement in medical affaires in Korea. Unlike the case of European countries where medical license was obtained after a long struggle with other practitioners, in Korea, medical license was given to doctors too easily from the state. And this experience played a very important role in the formation of identity of Korean doctors.
English Abstract ; History of Medicine, 20th Cent. ; Korea ; Licensure, Medical/*history

Treatment for patients with esophageal cancer remains unsatisfactory. Although surgery alone or chemoradiotherapy have been generally accepted as reasonable options for patients with locoregional esophageal cancer, 5-year survival rate of either management is about 20%. The limited success of single modality treatment using radiotherapy or surgery has led to the investigation of multimodality therapies, combining chemotherapy, radiotherapy, and surgery. However, the appropriateness of such therapies remains unanswered. A number of prospective randomized trials of trimodality therapy versus surgery alone suggest benefits of combined-modality therapy. Concurrent chemoradiotherapy is an alternative treatment in selected resectable cases to show potential benefits in survival and local control. Patients with complete response following neoadjuvant therapy have consistent, substantial benefits in survival. Pretreatment staging is necessary for standardization of patients undergoing treatment protocols and for outcome evaluation. Biologic markers can be used to predict response to therapy and might allow designation of treatment based on the individual tumor. In the future, clinical trials testing optimal integration of preoperative regimen including new drugs may impact on the prognosis of esophageal cancer.
Combined Modality Therapy ; English Abstract ; Esophageal Neoplasms/*therapy ; Humans

Recently, the detection of early gastric cancer (EGC) has increased because of the development of diagnostic techniques. Accordingly, new surgical procedures with minimal invasiveness including laparoscopic gastrectomy have been developed. Since the first laparoscopic-assisted distal gastrectomy (LADG) for EGC was performed, various new laparoscopic procedures, such as laparoscopic wedge resection (LWR) and intragastric mucosal resection (IGMR) have been developed for the treatment of EGC. Laparoscopic approaches to gastric cancer provide for minimal invasion, early recovery and decreased morbidity and mortality according to several short-term results. In the future, laparoscopic procedures for gastric cancer will be widely accepted in Korea, if the advantages of laparoscopic approaches are confirmed in randomized controlled trials of long-term outcomes.
English Abstract ; *Gastrectomy/methods ; Humans ; *Laparoscopy/methods ; Stomach Neoplasms/*surgery

Endoscopic mucosal resection (EMR) has come to play an increasingly important role in treatment of early cancer in gastrointestinal tract. Recent advances in EMR are very remarkable. These allow minimally invasive treatment of diseases that would otherwise require major surgery. The most important factors of EMR are accuracy and safety. Further improvement in both staging and resection technologies, as well as safety and short procedure time will ultimately conspire to make this an even more effective tool in the management of early cancer in gastrointestinal tract. EMR must prove to be safe for the majority of patients when performed by competent endoscopist. The new techniques will continue to solve the limitations of endoscopic treatment and its use will also continue to expand increasingly. Also, further studies are required to refine and standardize EMR. As EMR technology becomes more complex, necessitating the use of multiple accessories simultaneously, technical ease may be enhanced by simple adjunct devices. The future of EMR depends on extending its boundaries safely in a controlled setting of prospective clinical trials. I believe that current EMR techniques and devices are only the beginning of a new age in therapeutic endoscopy, the age of minimal invasive endosurgery, the next frontier.
English Abstract ; Gastric Mucosa/*surgery ; *Gastroscopy ; Humans ; Stomach Neoplasms/*surgery

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