Ethical consideration is an inseparable part of policy-making in modern society. Biomedical ethics is an interdisciplinary study of ethical issues that result from advances in medical practices and research. Because these issues often arise at the bedside, society must provide solutions or judgments that are effective and applicable. Thus, the development and progress of biomedical ethics has been made possible via the cooperation of experts from diverse backgrounds. The biomedical ethics discourse should not be seen as a conflict between values but as a collective activity for problem-solving. To support this perspective on ethics discourse, a historical perspective on biomedical ethics in Korea was given emphasis on the participants and their perspectives. Major cases and the changes resulting therefrom were discussed with the agenda proposed. The Korean situation with respect to ethics development shows the interactions between groups participating in policy development and its collaborative nature.
*Bioethics/history ; *Ethics, Medical/history ; Health Policy ; History, 20th Century ; History, 21st Century ; Humans ; Republic of Korea

No abstract available.
Endoscopy ; Humans ; Midazolam ; Propofol

OBJECTIVES: We investigated the effectiveness and safety when treated in schizophrenics with paliperidone palmitate, a long acting injectable antipsychotic. METHODS: This was a 24-week open-label study, performed at one center in Korea. The eligible patients with schizophrenia diagnosed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria were enrolled. Patients received long-acting paliperidone palmitate injection (234 mg, baseline; 156 mg, week 1 ; then once 4 weeks flexible dosing). Effectiveness assessments were measured by the Positive and Negative Syndrome Scale (PANSS), The Clinical Global Impression Severity Scale (CGI-S), The Personal and Social Performance (PSP) at baseline, week 1, every 4 weeks untill 24 weeks or endpoint. Safety assessments were measured by The Extrapyramidal Symptom Rating Scale (ESRS), body weight (BW) and incidence of adverse events. Oral antipsychotics were stopped or tapered off within next 14 days. RESULTS: Of 20 patients recruited, 9 patients (45%) completed the study. Paliperidone palmitate produced a significant improvement in PANSS total score from baseline to endpoint. The response rate was 75% [mean change (+/- SD) -25.9 +/- 14.4, all p < 0.001]. The CGI-S and PSP total scores significantly improved during 24 weeks (All p < 0.001). Eighty percent of patients reported adverse events and most common adverse events (> or = 10%) in paliperidone palmitate were anticholinergic adverse event, extrapyramidal symptoms, weight gain, akathisia, insomnia, headache, agitation, anxiety and GI trouble. ESRS score is not statistically significant, but tends to get better at the end of the study when compared to baseline. CONCLUSIONS: Our study results demonstrated maintained effectiveness and safety of paliperidone palmitate treatment in schizophrenics. And provides both clinicians and patients with a new choice of treatment that can improve the outcome of long term therapy. Their potential effectiveness and safety should be better addressed by future randomized-controlled trials.
Antipsychotic Agents ; Anxiety ; Body Weight ; Diagnostic and Statistical Manual of Mental Disorders ; Dihydroergotamine ; Headache ; Humans ; Incidence ; Korea ; Psychomotor Agitation ; Schizophrenia ; Sleep Initiation and Maintenance Disorders ; Weight Gain ; Paliperidone Palmitate

Biliary stents are widely used not only for palliative treatment of malignant biliary obstruction but also for benign biliary diseases. Each plastic stent or self-expandable metal stent (SEMS) has its own advantages, and a proper stent should be selected carefully for individual condition. To compensate and overcome several drawbacks of SEMS, functional self-expandable metal stent (FSEMS) has been developed with much progress so far. This article looks into the outcomes and defects of each stent type for benign biliary stricture and describes newly introduced FSEMSs according to their functional categories.
Bile Ducts, Extrahepatic ; Biliary Tract ; Constriction, Pathologic ; Drug-Eluting Stents ; Palliative Care ; Plastics ; Stents

Endoscopic retrograde cholangiopancreatography (ERCP)-induced complications, once occurred, can lead to significant morbidity. Commonly 5% to 10% of patients experience procedure related complications such as post-ERCP pancreatitis, biliary hemorrhage, and cholangitis, in descending order. However, complications such as perforation, pneumothorax, air embolism, splenic injury, and basket impaction are rare but are associated with high mortality if occurred. Such unexpected unusual complications might extend the length of hospitalization, require urgent surgical intervention, and put the patient in miserable condition leading to permanent disability or mortality. Although these ERCP-induced complications can be minimized by a skilled operator using advanced techniques and devices, the occurrence of unusual complications are hard to expect and induce very difficult management condition. In this review, we will focus on the uncommon complications related to ERCP. This review is also aimed at suggesting optimal endoscopic treatment strategies for several complications based on our institutional experiences.
Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Embolism, Air ; Endoscopy ; Hemorrhage ; Hospitalization ; Humans ; Pancreatitis ; Pneumothorax

COX-2 has been inappropriately overexpressed in various human malignancies, and is considered as one of the representative targetsfor the chemoprevention of inflammation-associated cancer. In order to assess the role of COX-2 in colitis-induced carcinogenesis,the selective COX-2 inhibitor celecoxib and COX-2 null mice were exploited in an azoxymethane (AOM)-initiated and dextransulfate sodium (DSS)-promoted murine colon carcinogenesis model. The administration of 2% DSS in drinking water for 1 week aftera single intraperitoneal injection of AOM produced colorectal adenomas in 83% of mice, whereas only 27% of mice given AOM alonedeveloped tumors. Oral administration of celecoxib significantly lowered the incidence as well as the multiplicity of colon tumors. Theexpression of COX-2 and inducible nitric oxide synthase (iNOS) was upregulated in the colon tissues of mice treated with AOM andDSS, and this was inhibited by celecoxib administration. Likewise, celecoxib treatment abrogated the DNA binding of NF-κB, a keytranscription factor responsible for regulating expression of aforementioned pro-inflammatory enzymes, which was associated withsuppression of IκBα degradation. In the COX-2 null (COX-2–/–) mice, there was about 30% reduction in the incidence of colon tumors,and the tumor multiplicity was also markedly reduced (7.7 ± 2.5 vs. 2.43 ± 1.4, P< 0.01). As both pharmacologic inhibition andgenetic ablation of COX-2 gene could not completely suppress colon tumor formation following treatment with AOM and DSS, it isspeculated that other pro-inflammatory mediators, including COX-1 and iNOS, should be additionally targeted to prevent inflammation-associated colon carcinogenesis.

BACKGROUND/AIMS: Hepatitis B virus (HBV) genotypes have distinct geographic distributions. The possibility of pathogenic differences among HBV genotypes has been suggested. We investigated the prevalence of HBV genotypes in Korea and the association between distinct genotypes and clinical outcomes. METHODS: Using a PCR-RFLP and sequencing, HBV genotypes were determined in 136 patients with chronic type B hepatitis. RESULTS: The genotype C was detected in 131 patients (96.3%), and other 5 patients (3.7%) had genotype B. There were no significant differences in sex, age, disease duration, ALT level, HBeAg/anti-HBe status, or HBeAg loss between genotype B and C patients. CONCLUSIONS: These results suggest that almost all patients with chronic hepatitis B are infected with genotype C. Genotypes do not influence the outcome of chronic hepatitis B patients in Korea.
Epidemiology ; Genotype* ; Hepatitis ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Korea ; Prevalence*

Lymphangioma of the stomach is known to be extremely rare, benign tumor, reported only 13 cases now, worldwidely, The lesions are soft, sponge like, and pinkish colored and filled with watery fluid exudates. The histologic examination reveals that lymphangiomas are composed of endothelium-lined spaces that contain a eosinophilic protein-rich fluid. They usually present as polypoid lesions because they are originated from submucosal layer. By endoscopy, they appear as smooth, soft, polypoid submucosal mass. The endoscopic ultrasonographic findings of gastric lyrnphangioma were cystic mass with multi-septation originated from submucosal layer of the stomach. Recently, We experienced a case of lymphangioma associated with early gastric cancer of the stomach. So we report this case with brief review of world literature.
Endoscopy ; Eosinophils ; Exudates and Transudates ; Lymphangioma* ; Porifera ; Stomach ; Stomach Neoplasms

BACKGROUND/AIMS: Endoscopic variceal ligation (EVL) has been effective modality for esophageal variceal bleeding, but recurrent bleeding occurs 20 to 40% of patients. So there has been an increased interest in the use of vasoactive drugs to lower portal hypertension and help control variceal bleeding before and after endoscopy. We investigated the efficacy of octreotide (OCT) infusion as an adjunct to EVL for preventing early rebleeding from varices. METHODS: From Jan. 1997 to Feb. 1999, fifty four patients with endoscopically documented esophageal variceal bleeding were included. The patients were randomly treated by EVL alone (EVL group, n=30) or EVL plus octreotide (EVL+OCT group, n=24). We evaluated the 5-ay and 6-eek rebleeding rate and 6-eek mortality. RESULTS: Baseline characteristics were similar in two group but hospital stay (p=0.028) and units of transfused blood (p=0.043) were significantly less in EVL+OCT group. There were no significant differences on 5-ay rebleeding rate (EVL group; 7%, EVL+OCT group; 0%) and 6-eek rebleeding rate (EVL group; 20%, EVL+OCT group; 4%). CONCLUSIONS: The combined therapy did not decrease early rebleeding and mortality, but it was superior to EVL alone in hospital course such as requirement of transfusion and duration of hospitalization.
Endoscopy ; Esophageal and Gastric Varices* ; Hemorrhage ; Hospitalization ; Humans ; Hypertension, Portal ; Length of Stay ; Ligation* ; Mortality ; Octreotide* ; Varicose Veins