This study is to compare the clinical and cost effectiveness of various pharmacologic therapies with of without endoscopic procedure in the Forrest II ulcer.

Between May 2001 and June 2002, total of 58 Forrest II bleeding activity patients (37 cases of NBVV, 6 adherent blood clots, 9 flat red spot, and 6 flat black spot) with gastric ulcer(32 cases) and duodenal ulcer(26 cases) were analyzed. UGI endoscopy was performed within 12 hours of the first bleeding episodes, and underwent repetitive endoscopy after 48h. All the patients were randomly assigned to receive somatostatin(group I), PPI(omeparzole : group II), only H2 blocker (famotidine, group III), or endoscopic injection therapy followed by famotidine (group IV). We compared with rebleeding rates, changes of ulcer size, and modified estimated costs for 3 day-hospital in four groups respectively.

1) Twelve patients experienced rebleeding(20.7%). 2) The rates of rebleeding were 16.6% (2/12) in group I, 28.6%(4/14) in group II, 5.9%(1/17) in group III, 26.7% in group IV. There was no significant difference in rebleeding rate among the groups, but there was low rebleeding tendency in group III, compared with group II(p=0.087). 3) Type of stigmata including non-bleeding visible vessels and adherent clots were associated with an increased rate of recurrent bleeding(p=0.01). 4) When modified estimated costs were calculated, group III could be treated at the lowest cost(p<0.05).

In Forrest II bleeding ulcer, medical therapy, especially famotidine could be suggested prudently as a proper treatment modality for this lesion, considering the cost-effectiveness.

Unexpected carcinoma of gallbaldder(GB) can be found in 1-2% of specimens after surgery of benign biliary disease. This study was designed to investigate the clinicopathological and radiological characteristics of unexpected GB cancer presumed benign biliary disease and compare with originally diagnosed GB cancer.

The modical records of nineteen patients(5 males and 14 females, mean age : 64±9 years) with unexpected GB cancer diagnosed postoperatively(Group 1 : cholecystitis, 12 cases ; GB empyema, 4 cases ; cholecystitis with bile duct stone, 3 cases) and thirty seven patients (12males and 25 females, mean age : 68±11 years) with originally diagnosed GB cancer(Group 2) were retrospectively reviewed at Ewha Womans university Mokdong hospital from October, 1993 to March, 1999.

Clinical findings including right upper quadrant pain, fever, and chilling were pre-dominant in group 1 and general weakness, anorexia, and weight loss were predominant in group 2. Ultrasonographic findings of the group 1 were not typical to detect GB cacer Diffuse thickened GB wall showed 47.3% and the gallstone showed 89.5% in group 1. The mass of thickened GB wall irregularly revealed in all and gallstone showed in 50% of group 2. The TMN stage of goup 1 revealed earlier stage than group 2. The curative resection was performed in 84.2% and 10% in group 1 and 2, respectively.

The stage of unexpected GB cancer revealed relatively early stage and the curative resection rate was higher than originally diagnosed GB cancer. Therefore, the careful and detail intraoperative histologic examination of considered in patient with clinical features of benign biliary disease to detect early and improve prognosis in the patients of GB cancer.

Pancreatitis is the most common and serious complication of diagnostic and therapeutic ERCP. On the basis of several reports, corticostroid or octreotide might be effective in this regard. The aim of this study was to determine whether the pharmacologic agents(stroid and octreotide) prevent post-ERCP pancreatitis.

Patients received an intravenous infusion of hydrcortisone(100mg) and octreotide (0.2mg bolus) in treated group Tmmediately before endoscopy. A total of 140 patients(73men and 67 women, with an average age of 61.5 yr) who were scheduled to undergo diagnostic or therapeutic ERCP. Nine patients were excluded from the final evaluation for incomplete records. The remaining 131 patients, 61 in the treated group and 70 in the control group, were analyzed.

The overall frequency of hyperamylasmia and pancreatitis were 33.6%(44/131) and 7.6%(10/131), respectively. The all pancreatitis were mild. There was no difference between the groups with the incidence and severity of pancreatitis. The procedure-induced pancreatitis occured in 5 of 61(8.2%) patients treated with hydrocortisone and octreotide and 5 of 70(7.2%) patients in the control group(p=ns). the groups were similar with regard to desmographic characteristics, type of procedure performed(diagnostic or therapeutic), the presence of diverticulum, visualization of pancreatic duct. The only risk factor of ERCP-pancreatitis is the visualization of pancreatic duct in both groups.

Prophylactic administered corticosteroid and octreotide did not prevent of post-ERCP pancreatitis. Pancreatic injury may be only related to maneuver of pancreatic duct.

Recently the advantages of a laparoscopy-assisted distal gastrectomy(LADG) including lymphadenectomy for early gastric cancer(EGC) have been reported. The purpose of this study was to perform a prospective randomized trial comparing the early results of LADO with open distal gastrectomy in EGC.

Forty-seven patients, endoscopically diagnosed as EGC on antrum and lower body, were included during the period from November 2001 to August 2003. Using a random number table, 23 patients were assigned to open group(group O) and 24 patients to LADG group(group L). Radical distal subtota 1gastrectomy with gastroduodenostomy was performed in all patients. The clinicopathologic findings, postoperative recovery, and morbidity were compared between two groups.

Age, sex, body weight, associated disease, history of previous abdominal surgery, location of lesion, size, gross type of EGC, and histologic differentiation were similar in both groups. On permanent pathologic examination, all cases of group O were diagnosed as EGC and in the group L, 21 cases were EGC, 3 cases were advanced cancer. The mean operation time was significantly shorter in the group L, but estimated blood loss and transfusion amount were similar in both groups. The mean postoperative days of first flatus, starting day of diet, postoperative hospital stay were shorter and deration of analgesic administered were lower in group O, but they did not reach statistical significance. The mean numbers of harvested lymph nodes were 38.1 in the group O and 31.8 in the group L, which was not statistically significant(p=0.098). Postoperative pulmonary complication based on chest X-ray occurred more frequently in the group O (p=0.043). There is no recurrence of disease in both groups in follow-ups.

LADG has advantage in terms of less phlmonary complications while main-taining the curatility. This is the preliminary result of prospective randomized study and the long-term results should be followed.

The purpose of study is to assess the clinical characteristics of complicated Meckel's diverticulum in children.

A retrospective review of pediatric cases of complicated Meckel's diverticulae that were surgically treated at Ewha Womans University Hospital from 1985 was performed. The charts were reviewed for the age and sex of the patients, operation finding, treatment, and outcome.

A total 13 patients with a complicated Meckel's diverticulum were identified. There were 8 boys(61.5%) and 5 girls (38.5%) with a mean age of 5.3 years (range, 1month to 14years). Presenting signs and symptoms included digestive hemorrhage (6), intestinal obstruction(4), perforation (1), intussusception due to inverted Meckel's diverticulum (1) and diverticulitis (1). A^99m technetium pertechnetate scintiscan was positive in 3 of 4 patients. Barium contrast studies and colonoscopys were not diagnostic. The mean distance from the ileocecal valve to the diverticulum was 47.0±15.7cm. Average length of the diverticulum was approximately 4.7±3.0cm. Segmental small bowel resection including Meckel's diverticulum (84.6%) or wedge excision(15.4%) was done for treatment. In the bleeding group, ectopic gastric mucosa was present in 5 of 6 patients. Postoperative morbidity and mortality was each 0%.

The results of this study draw attention to the fact that the complicated Meckel's diverticulum must be suspected in children with acute abdomen or gastrointestinal bleeding.

To investigate whether polymorphism of gene encoding estrogen receptor-α is associated with the risk of endometriosis in Korean women.

We investigated 136 patients with histopathologically confirmed endometriosis rAFS stage III/IV and 251 control group women who were surgically proven to have no endometriosis. Polymerase chain reaction(PCR) and restriction fragment length polymorphism (RFLP) of PCR products were done to determine each participant's estrogen receptor-α genotype.

The distridution according to PvuII genetic polymorphism of estrogen receptor-α were as follows. PP, Pp and pp were 14.7%(20 women), 39.0%(53 women) and 46.3%(63 women) in the study group and 13.9%(35 women), 38.6%(98 women) and 47.4%(119 women) in the control group, respectively. There was no significant difference between the study group and the control group.

The results suggest that estrogen receptor-α genetic polymorphism may not be associated with the development of endometriosis in Korean women.

Acute disseminated encephalomyelitis(ADEM) is an acute demyelinating autoimmune inflammatory disease of the central nervous system which develops after infection of vaccination. It may be fatal, and produce a permanent residual static disability or fully recover. We retrospectively studied 14 cases to investigate the clinical findings and outcome of ADEM.

14cases of ADEM diagnosed at Ewha Womans University Mokdong Hospital from 1998 to 2003 were retrospectively reviewed.

The age of onset was 5 years±7.8 months and no seasonal clustering was found. The time of onset of symptoms was between 3 to 30 days. The preceding events were nonspecific upper respiratory infections in 9 cases, aseptic meningitis in 4 cases, and gastroenteritis in one case. The initial symptoms were seizure, altered consciousness, hemiparesis, fever, headache, and vomiting. Brain MRI showed multifocal high signal intensity lesions on T2 weighted image mainly in the cerebral whith matter, basal ganglia and periventricular white matter. EEG was performed in some cases and showed generalized or focal slow waves and only one case showed focal spikes. Patients were treated with IV globulin and methylprednisolone and the symptoms improved within 3-7 days after treatment. All patients were followed up for more than 2 months and most of them fully recovered except two.

ADEM presents in various clinical manifestations depending on its involvement of the brain lesions. Most cases recovered fully but in some cases, residual permanent neurologic sequelae remained.

Ureteral stent is commonly used after ureterscopic stone removal(URS). However, there is no definitive clinical criteria in inserting the ureteral stent after URS. Patients often complain of bladder irritative symptoms, hematuria. flank pain and additive endoscopic prodedure is necessary to remove the ureteral stent. Therefore, we studied the clinical epicacy of selective ureteral stenting only when it is required.

Of the patients who was taken URS, the following patients were exclu-ded from stent insertion ; 1) Patients who have mild hydronephrosis or symptoms less than 1week. 2) Patients who were able to insert the ureteroscope through the ureteral orifice without difficulty. 3) Patients who hardly have ureteral mucosal damage seen through the ureteroscopic field after the removal of ureteral stone. 4) Patients who did not need the additional lithoclast during the removal of ureteral stone. Other than the above patients and those with stones above the mid-ureter, a 6Fr. ureteral stent was inserted and kept for 3weeks. There were 29 unstented patients and 38 stented patients.

The average age of the non-stenting and stenting group were 37.5 years old and 39.7 years old and the average stone size were 0.68cm and 0.80cm. The average operation time was 3 minutes in the non-stenting and 8minutes(including ureteral stent insertion time) in the stenting group. Hospital stay was 3 days in both groups. Intermittent gross hematuria and irritative symptoms of the bladder was shown for 3 weeks after operation in most of the patients(32cases, 84.2%) of the stenting group while those in the unstenting group, the symptoms were relieved after2days after operation. Although mild flank pain was shown in few patients(4 cases, 13.8%) of the non-stenting group, severe pain requiring intravenous analgesics was not seen in both groups. There were no specific findings in the intravenous urography which was done at 6 weeks after operation, and no hematuria and pyuria was found in both groups.

The selective placement of ureteral stent following the ureteroscopic removal of stone did not bring specfic complications. We believe that ureteral stent insertion will minimize the inconvenience especially in patients who need to return to their everyday living immediately after operation. Thus ureteral stent insertion should be used in limited situations.

EEG is a record of electronic signals of brain. If there are effective methods for analysis of EEG signal it can be used as a diagnostic tool for diseases related to brain function. We developed a new diagnostic system for analysis of EEG by using nonlinear dynamic theory.

We made a basic computer program which was designed to analysis of pattern of EEG. For analysis of pattern, EEG signal was processed by variable experimental analytical methods and grouped by common pattern.

Program was composed of multiple systems. Signal generating system was composed of Lorenz signal generation and Rossler signal generation parts. EEG processing system was composed of Normalization, Band pass filtering, First Second difference, Add random noise and Sur-rogate making parts. EEG analyses system was composed of Spectral analyses, Phase space analyses, Correlation analyses and Mode analyses parts. Pattern recognition and grouping system was com-posed of data format, Power spectrum, Neural network process and Classification parts.

We developed a basic computer program for systemic analysis of EEG by Nonlinear analysis methods.

Subacute necrotizing lymphadenitis is a self-limiting disorder that typically affects cervical lymph nodes of young women. Although autoimmune reaction and a viral etiology have been suggested, the definite cause has been uncertain. We evaluated the association of M. tuberculosis and non-tuberculous mycobacterium with this disorder.

From 1994 to 2002, Clinicopathological findings of 38 cases were reviewed. Multiplex nested PCR was done using DNA extracted from paraffin-embedded tissue. Sequencing analysis was done to the cases showing positive band.

3 cases among 38(7.89%) showed amplified non-tuberculous mycobacterium DNA. Two cases are M. gordonae and one is M. fortuitum by sequencing analysis. All cases revealed no positive band for M. tuberculosis. Negative control cases showed no bands for both mycobacteriums.

Although 7.89% of cases showed amplified non-tuberculous mycobacterium DNA, more study is needed to confirm the association of non-tuberculous mycobacterium with subacute necrotizing lymphadenitis.

To investigate the time of rearrangement of the TCR gene in the process of NKT cell differentiation from CD34+ human cord blood cells in vitro.

We isolated the CD34+ human cord blood cells and induced the differentiation of NKT cells by liquid culture including IL-15, FL and SCF for 30 days. In order to detect the time of TCR gene rearrangement in differentiated NKT cell, we performed PCR for TCR-rearrangement excision circles (TRECs) with isolated DNA.

Signal joint TREC first appeared on day 4 or day 8 and continuously existed until day 30. Between day 9 and day 21, cells showed high output of coding joint TRECs after signal joint rearrangement.

In differentiated NKT cells, TCR gene rearrangement started within a week after culture started and mostly occurred in 2 to 3 weeks after culture started.

Src family tyrosine kinases(TK) have been found to be involved in LPS induction of signal cascades. Furthermore Lipopolysaccharide(LPS) or Tumor necrosis factor alpha (TNF-α) activate nuclear transcription factor κB(NF-κB) by inducing serine or tyrosine phosphorylation of the inhibitory subunit of NF-κ B(I κ B-α). In this study, it is our purpose to search the role of Src TK in LPS induced activation of NF-κ B and NF-κ B dependent induced inflammatory factors.

Nuclear extracts were prepared from RAW 264.7 cells pretreated with damnacanthal or PP1 and then stimulate with LPS. After that, we figured out the dffects of inhibition of Src family kinases on LPS-induced activation of NF-κB by EMSA. We investigated effects of damnacanthal of PP1 on the production of NO by Griess assay and LPS-induced serine phosphorylation and degradation of Iκ B-α by Western blots in LPS-stimulated RAW263.7 cells.

Inhibition of Src TK with damnacanthal or PP1 blocked LPS-induced NF-κB activation at the range of nanomolar concentrations. Substantial inhibition in LPS-induced production of NO was also observed in cells treated with damnacanthal or PP1. These kinase inhibitors blocked LPS-induced the serine phosphorylation, and the degradation of Iκ B-α.

we investigated the role of Src TK in NF-κ B activation and production of nitric oxide (NO) in LPS stimulated RAW 264.7 macrophages and the underlying mechanism by which Src TK play a role in LPS-induction of the possible pathways leading to NF-κ B activation. Src kinase specific inhibitors, damnacanthal and PP1 blocked LPS induced activating NF-κ B and producing Nitric Oxide in Raw 264.7 machrophages. Moreover, Damnacanthal and PP1 inhibited LPS induced serine phosphorylation and degradation of Iκ B-α.

This study was to evaluate the effectiveness of the government-funded subsidized occupational health program for small-scale enterprises(GSOHP_SSE) by occupational health communication in workplace.

We sampled the 1,835 enterprises of study by proportional stratified random sampling among industries of supported and not supported by GSOHP_SSE in Seoul, Ansan, Daejeon, Kwangjoo and Pohang. Information on the general characteristics of enterprises and respondants and occupational health communication in the workplace was collected on self-reported questionnaires by post-survey between December 6 and 15 in 2001. We received answers from 463 enterprises and analyzed 228 enterprises through data-cleaning by logistic regression to evaluate effectiveness of GSOHP-SSE about occupational health communication in the workplace.

By multiple logistic regression analysis, GSOHP_SSE turned out not to be statistically significant factor in all dependent variables about occupational health communication in the workplace. The concern of owner(odds ratio (below OR) ; 1.63, 95% confidence interval(below 95% CI) ; 0.38-7.01), formation(OR ; 3.67, 95% CI ; 1.00-13.44) and empowerment(OR ; 1.48, 95% CI ; 0.25-8.91) of health manager, request about occupational health problem of health manager(OR ;4.48, 95% CI ; 0.97-20.57) and occupational health communication of owner (OR ; 3.07, 95% CI ; 0.81-11.71) had the trend increasing OR in the industries supported GSOHP_SSE relative to the industries not supported. But in recognition of possibility on occupational health communication of laborers, OR of GSOHP_SSE was decreased in 0.53(95% CI ; 0.11-2.44).

This study found that the GSOHP_SSE was some effective to the side of employer and health manager, but had a limitation about change of communication culture useful to the laborers. We suggested the laborer-centered health training programs or the empowerment-based health training programs for effective occupational health management in the workplace.

The purpose of this study is to deliver effective worksite health management by specifying job of occupational physician, occupational nurse, occupational hygienist and making job reference manual and health performance audit. Therefore, We can contribute to disease prevention and health promotion of workers by enhancing quality of worksite health management.

The methodology of making performance audit is comprised of developing audit questions and weighting the questions. Measures are made by scoring the values. The questionnaires were grouped by the categories and sections. This occupational audit was distributed to the health personnel of 350 workplaces by mail. The self-administered results were returned and analyzed.

We plot the field of occupational health service by basic policy, preventive health service, health care, administration, and other services. We gave the weight A on the primary job, B on the supplementary job, and C on the minor job. This weight was made through the delphi procedures where 30 specialists joined. Basic policy got score of 16.1% preventive health service got 36.5%, health care 20.4%, administration 10.9%, and other services 10.1%. Further weightings on the questionnaire sections were made through the survey on specialists and final weighting on each questionnaire was made by making formula considering weights of each stage. The audit was composed of 96 questions which has dichotomos scales and full score was 1,000. Person-nels from 80 workplaces (23%) replied the audit and the scores of physicians, nurses, and hygienists were 608.6, 587.1 and 535.4, respectively, all a little higher than 500.

The health performance audit can be used by the sorksite health personnels providing health service. However, this work would not be complete without further comprehe-sion and application in the real settings.

This study aims to survey of the health examination for occupational disease using similar exposure group(SEG).

We surveyed industrial hygienists and occupational physicians about the health screening using SEG. We randomly sampled 100 industrial hygienists and 100 occupational physicians from the membership lists. We collected the heneral characteristics and professional opinion of health examination for occupational disease screening using SEG. The self-reported questionnaires were collected by mail from July 1st to July 20th in 1999.

Seventy three percent of respondents answered they knew the concepts of SEG. Occupational hygienists were more likely to know the SEG than occupational physician, but it was not statistically significant. Both of occupational hygienists and physicians pointed out that "Improvement of hazardous exposure monitoring" should be on the first assumption for development of health examination using SEG. The second assumption would be "Advance of toxicologic knowledge". And next was "Improvement of appraisal for health effect" from occupational physician, but "Administrative will to reform" from occupational hygienist.

It is desirable to health examination based on SEG rather than on individual hazardous exposure. For this approach, we have to improve the monitoring of hazardous exposure first.