Reactive oxygen species (ROS) such as hydrogen peroxide, superoxide anion and hydroky radicals are produced in various physiologic and pathologic conditions and involved in many cellular processes as proliferation, differentiation and apoptosis. Studies investigating the role of ROS in various cellular behaviors especially in proliferation and apoptosis have been widely conducted in many cell types but the role of ROS in nontransformed human hepatocyte differentiation has not been investigated yet. thus we were going to elucidate the roleof ROS on human hepatocyte differentiaiton using sodium butyrate (SB) induced hepatocyte differentiation model of our own establishment.

Intracellular ROS and apoptotic cell death were monitored by flowcytometry using peroxide sensitive probe (Dicholorofluorscein diacetate) and Annexin V/Propidium iodide, respectively. Urea nitrogen in culture media was measured by colorimetric methods. Ornithine transcarbamylase(OTC) and albumin trasncription was evaluated by RT-PCR.

Intracellular ROS production was increased by SB. SB induced urea production was significantly decreased with antioxidant treatment (p<0.05) and SB induced OTC and albumin transcription were also attenuated with antioxidant treatment. SB induced increase in apoptosiswas significantly inhibited by antioxidant treatment (p<0.05).

ROS produced during the process of sodium butyrate induced human hepatocyte differentiation auguments hepatoctye differentiation and apoptosis.

Pyogenic liver abscess is a potentially life-threatening disease with substantial mortality rate. With the recent advances in diagnostic modalities and new treatment strategies, the overall mortality of pyogenic liver abscess has been decreased significantly but stillhigh mortality rates are recorded in patients with old age, multiple abscesses, malignant biliary obstruction and inadequate drainage. Therefore pyogenic liver abscess remains a major clinical challenge. We are going to investigate the current clinical features of pyogenic liver abscess.

Medical records of those who admitted to the Ewha Womans University Mokdong Hospital since 1993 and diagnosed as having Pyogenic liver abscess were reviewed. A total of 88 pyogenic liver abscess patients was detected and their clinical presentation, bacteriologic etiologies, comorbidities and treatment results were investigated.

Fifty male and 38 female (1.3 :1) patients were enrolled and the mean age was 59years. The most common presenting symptom was fever/chill (77%) followed by abdominal pain(64%), nausea/vomiting (42%) and general weakness (41%). Diabetes mellitus was combined in 17% of the patients and most of pyogenic liver abscesses were induced by ascending biliary infection (43%) or unknown cause (52%). Leukocytosis was evident in 74% of the patients and elevated akaline phosphatase in 52%. Sixty five percent of the abscess cavities were located inright lobe of the liver and most of them were solitary (73%). Pus culture was more efficient than blood culture for the detection of causative microorganis and Klebsiella pnemoniae was most commonly isolated. Percutaneous aspiration or drainge procedures were applicated in 65% of the patients and three mortalities (3%) were recorded while most of the patients were improved.

Rapid diagnosis of pyogenic liver abscess can be done through a complete history taking, physical examination and a prompt imaging studies and aggressive application of percutaneous aspiration or drainage of the abscess cavity with the empirical antibiotic administration targetting gram-negative aerobe may contribute to the improvement of the mangement of pyogenic liver abscess.

The role of Helicobacter pylori(HP) in benign and malignant pancreatico-biliary tract disease is concerned in recent papers. The urease gene of Hp were found in human bile, and bacteria morphologically resembling Hp were found in resected gallbladder mucosa from patients with gallbladder disease. It was hypothesized that there is an association between the presence of Hp in bile and pancreatico-biliary disease. The aims of this study are to examine if Hp exist in the bile juice and to investigate whether Hp plays a role in the pancreatico-biliary disease.

Thirty-eight patients (18 males and 20 females, mean age 71 ?27yr ; range 45-92yr) with gallstone and malignant pancreatico-biliary disease were enrolled in this study ; 23 cases were gallstone diseases, 10 cases were cholangiocarcinomas, and 5 cases were pancreatic cancers. Thirty-eight controls were age- and sex-matched and enrolled from subject attending routine medical check-up. The presence of Hp in stomach was confirmed by ?⁴C-breath test. The polymerase chain reaction (PCR) assay was used to detect the Hp in bile.

The Hp-positive rate in stomach was much higher in control (26/38,68.4%) than the patients with pancreatico-biliary disease(l1/38, 28.9%) (p<0.01). The Hp-positive rate in bile of pancreatico-biliary disease was 18.4% but, there is no relation between of the presence of Hp in the stomach and in the bile (p=0.33). Also there was no significant difference of the presence of Hp in bile (p>0.05) and stomach (p=0.28) between benign and malignant disease.

The Hp-positive rate in bile was similar in benign and malignant pancreatico-biliary disease. But Hp may not be important risk factor in pancreatico-biliary disease in Hp-prevatent country like south Korea.

Chronic HBV infection is the main cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma in Korea. Hepatic flbrosis progresses as the duration of HBV infection prolongs therefore more advanced histologic findings are anticipated in patients with perinatally acquired HBV infection than in patients of the same age who acquired HBV otherwise. We are going to investigate the histologic findings of young adult patients with chronic hepatitis B with respect to maternal HBsAg status, duration of HBV possession and senun HBeAg starus and ALf levels.

A total of 96 HBsAg positive young adult male patients who visited our hospital forliver biopsy were enrolled and their histologic findings were analysed according to the standardcriteria. The medical records of the patients were reviewed and supplementary information weretaken via telephone interviews.

Hepatic inflammatory scores and fibrosis stages were increased as the serum ALf level increased. Histologic findings showed no significant differences according to the duration of HBV infection, serostatus of HBeAg, the number of HBsAg positive cells and matemal senun HBsAg status.

In young adult patients with chronic hepatitis 3, the hepatic histologic findings were worsen as the serum ALf level increased and associated with neither the HBeAg status of the patient nor the matemal HBsAg status.

Inflammatory response may play role in symptomatic nerve irritation that is associated herniated disc. Steroids decrease neurogenic inflamation, inhibit phospholipase A2 and produce membrane stabilization that result in pain relief. Local anesthetics are believed to break the cycle of pain that exists between local pain and a secondary muscle spasm. Epidural block with steroid combined with local anesthetics(EBSL) are recommended in patients with sign and symptoms of nerve root irritation. The purpose of this study was to asses of ESBL.

A retrospective study undertaken of 20 patients who received ESBL from May 2004 to November 2005 at the pain clinic of Mokdong Hospital Ewha Womans Medical Center. The mean age of the patients was 52, with range from 18-82 years. Nine patients was male, eleven were female. The etiologies of the pain were low back strain(3 patients), bulging disc(9 patients), degenerative disc(4 patients), lumbar stenosis(2 patients) and spondylolisthesis(2 patients). Diagnostic workouts were history, physical and neurologic examinations, and labo-rative studies including simple X-ray and magnetic resonance image. The steroid preparation usedis methylprednisolone and the use of dilute local anesthetics Is mepibacaine. The method of technique of EBSL was median approach with loss of resistance technique. The clinical responsefall into four categories, 6 months follow up after therapy. An excellent response was defined ascomplete resolution of presenting symptoms. A good response was judged to greater than 75%improvement in symptoms with full resumption of the patients life style. A fair response was defined as improvement in the patients condition, whereas a poor response indicated little or noimprovement. The total numbers of blocks were 48 in 20 patients and 2.4/per patient. The duration symptoms within one month were 8 patients and the other 12 patients over one month.

A detailed follow-up of 20 patients with EBSL showed a successful rate(good to excellent) 65%, fair 25%, and poor 10%. The effective responses of EBSL were depend on the etiologies, duration of pains and patients age. All patients of low back strain with one month duration or less have a response rate of very successful excellent. Also all patient with bulging disc who present with pain within one month have a response rate of excellent 3(60%), good 2(40%) and the patient who present with pain of over one month or more have a response rate excellent 1(25%), fair 2(50%) and poor 1(25%). All patients of degenerative disc present with pain of over one month have 50% relative success rate and good 2 patients. The response rate of two patients of spinal stenosis and two patients of spondylolisthesis present pain of long time(2-6 months) and response rate showed fair 3, poor 1, and 0% of successful rate.

EBSL can safely performed and its efficacy has been established in patients with low back strain and bulging disc. The success of this therapeutic procedure depends on attention to selected of patient etiologies and concomitant therapies. In addition, well controlled studics are needed to evaluate any effectivness of EBSL on back pain and radiculopathy.

The aim of this study was to analyze the diskibution pattern of the 38 mineral elements in the patients with chronic urogenital diseases such as benign prostatic hyperplasia(BPH), andropause, erectile dysfunction, menopause, overactive bladder and stress urinary incontinence, which were appeared as the result of various life factors including the ageing.

Hairs were collected in the occipital scalp area and analyzed mineral status in theme thod of inductive coupled plasma mass spectroscopy (Trace Element, INC. ; TEI, USA). 15mandatory nourishment minerals, 15 additional minerals,8 heavy metals and the ratio of Ca/P Na/K, Ca/K, Zn/cu, Na/Mg, Ca/Mg, Fe/Cu were measured. The results were classified as each disease and compared.

The disease which showed high rate of patient with increased calcium was menopause(85.7%) and overactive bladder (OAB) (61.9%). The disease which showed high rate of patient with increased magnesium was menopause (57.1%). The disease which showed high rate of patient with increased sodium was stress urinary incontinence (SH) (42.9%). Other minerals didn't show particular distribution by the disease. The average ratio of Caf was increased in all diseases and the degree of the increase was high in menopause, OAB and SUI. The average ratio of Zn/Cu was increased only in menopause. The average ratio of Ca/K was increased in all diseases and the degree of the increase was high in menopause, OAB and SH. The average ratio of Zn/Cu was within normal range in all diseases. The average ratio of Na/Mg was increased only in BPH and was decreased in menopause, andropause and OAB. The average ratio of Ca/Mg was increased in all diseases and the degree of the increase was the highest in OAB.

The distribution pattern of mineral elements according to chronic urogenital diseases was distinctive. Thus we consider that mineral supplement remedies suitable to the eachdisease can be recommended.

Chemical constituent of urinary stone is important for the management and the prevention of recurrence. We performed chemical analysis of the urinary stone and investigatedits chemical constituent.

From January 2003 to December 2005, stone fragments were collected after extracorporeal shock wave lithotripsy (ESWL, n=43), or removal by endoscopic procedure such as ureteroscopy (URS, n=93) and open surgical procedure such as cystolithotomy (n=8). So we had stone fragments from 144 patients totally.

80 stone fragments were collected from male (55.6%), 64 stones from female (44.4%), and male to female ratio was 1.25 : 1. The mean age between males (mean age ; 47.2 years old)and females (mean age ,47.9 years old) was not different. The most frequently found location of urinary stones was ureter(91.0%) Of 144 patients in urine analysis,54 had pyuria (37.5%). The most frequently found constituent in stone fragments was that of calcium(n=119 , 82.6%). The 2nd constituent was phosphate (n=82 ; 56.9%). The 3^rd was uric acid(n=33 ; 22.9%). The other constituents were ammonium(n=24 ; 16.6%) , carbonate (n=18 , 12.5%), magnesium (n=11 ; 7.6%). oxalate (n=3 ; 2.1%). Struvite stone (MAP stone ; magnesium+ammonium+phosphate)were found in 5 patients (3.5%) All of 5 patients having strivite stone had pyuria(100%).

Calcium is the most common chemical constituent in urinary stone. Urinary infection was complication in 100% of patients with MAP stones.

Recently, antibiotic resistant organisms have increasing tendency. So, we studied causative organisms in urinary tract infection and investigated the resistance to each antibiotics.

From January 2004 to March 2004, uropathogens and antibiotic sensitivity tests in urine culture of patients with urinary tract infection were analyzed retrospectively. One hundredeleven women and 51 men in 168 adults were included.

Incidence of positive urine culture was 66.1% in women, and 33.9% in men. Mean age was 62.6 years old in men, and 61.7 years old in women. The most common uropathogen was E. coli(50.4%), followed by K. pneumoniae or(21.3%), P. aeruginosa(9.2%). In adult men, the most common uropathogen was S. marceacencs(46.5%). E. coli has the resistance to almost all antibiotics. In E. coli, the resistant rates on each antibiotic were ampicillin(73.8%), piperacillin(66.7%), levofloxacin(37.2%), gentamicin(35.8%), TMP/SMX(31.7%). ciprofloxacin(30.3%) inodor. Extended Spectrum β-lactamase(ESBL) producing organisms were found in E. coli(20 patients) and K. pneumoniae(3 patients).

E. coli was the most common uropathogen. Especially, ESBL producing organisms were Increasing.

Comparing with the traditional curriculum which provides mainly basic medical science training in the first 2 years, the early exposure to clinical medicine is a major trend of medical education through recent decades. However the timing, extent, content and methods of the 'early clinical education' are not defined clearly and the application is various. Preparing the transformation of the curriculum from undergraduate to graduate entry at Ewha medical school, the concepts of 'early clinical exposure' into our new curriculum needs to be clear. We want to decide how early and how deep and what contents of clinical knowledge and skills are to be introduced in the new curriculum.

Literature review. Interview with a developer and the participants of the 'early clinical education' curricula which has been applied in the Carver College of Medicine, University of lowa since 1998.

The early exposure of clinical knowledge and skills has been introduced world widely and many curricula have it as early as the very week of entrance. Problem based learning, standardized patient program, clinical skill labs and clinical mentoring, etc. are being used with various modification. Early clinical education enhanced the loaming interest and professional minds to the medical students as well as their achievements.

The early clinical education will be applied to the new curriculum of the graduate school of medicine starting 2007 in Ewha Medical School.