• Korean Journal of Head & Neck Oncology
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• v.6 no.2
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• pp.79-84
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• 1990

This paper is a review of our experience with radical resection for cancer of the oral cavity with particular emphasis upon the value of myocutaneous(i.e., musculocutanous) flaps employed in the surgical reconstruction in patient survival. During the past 15 years, 98 patients underwent resection of cancer arising in the oral cavity and oropharynx. Of these, 14 had composite resections in which the mandible was not sectioned, and 4 underwent en bloc resections without neck dissections in the face of post-radiation recurrence. When these excluded, 84 patients who underwent COMMANDO procedures with or without myocutaneous flaps were suitable for analysis of recurrence and survival according to the various surgical technics employed. 1) According to the surgical technic, there were 24 standard COMMANDO procedures in whom no regional or myocutanous flap was used; 12 patients who underwent reconstruction employing a forehead flap; 19 patients in whom a posterior cervical 'nape' flap was employed; 27 patients who underwent myocutaneous or osteo-myocutaneous flap repair; and two patients who had double flap repair. 2) The uncorrected two-year disease free survival was 41% for standard COMMANDOs, 17% for forehead flap COMMANDOs; 35% for nape flap COMMANDOs; and 35% for myocutaneous flap COMMANDO procedures. 3) The two-year disease-free survival by Stage was 100% in Stage I, 45% in Stage II, 41% in Stage III, and 18% in Stage IV. 4) When myocutanous flaps cases were compared with Group I, comprised of matched historical controls including both Standard COMMANDOs and those who had undergone regional flap repairs(that is, forehead and nape flap COMMANDOs)there was no difference, both groups showing a 40% 2-year disease-free survival. 5) When musculocutanous flap cases were compared with Goup II, which was composed of matched historical controis limited to patients who had undergone regional flap repairs(that is, forehead and nape flap cases only)there was no difference, both groups showing a 27% 2-year desease-free survival. 6) When musculocutanous flap cases were compared with Group III, composed of patients who had undergone classic COMMANDO procedures without any sort of flap repair, there was a striking difference; the patients undergoing MC flap repair showed 50% 2-year disease-free survival, whereas the classic COMMANDO cases showed a 25% survival free of disease. 7) Locoregional recurrence was also evaluated in the four categories; for standard COMMANDO cases it was 25%, for nape flap cases 26% ; for forehead flap cases, 33%, and for the musculocutaneous flap cases, the lowest recurrence rate, 22%. These results are of particular significance in view of the fact that the proportion of advanced cases(Stage III and IV)in each category was 67% of standard cases, 79% of nape flap patients, 100% of forehead flap cases, and 96% of musculocutaneous flap cases.

• Journal of the korean academy of Pediatric Dentistry
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• v.26 no.2
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• pp.377-398
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• 1999

Calcium fluoride, created by topical fluoride application, is the reservoir for fluoride ion regulated by pH in the oral environment. Therefore, the amount and the maintenance of calcium fluoride have an important role in preventing dental caries. The aim of this study is to evaluate the effect of Nd:YAG laser irradiation on the generation of calcium fluoride and the acid resistance of tooth enamel. The bovine anterior permanent teeth were prepared (n=276), and divided into following groups : no treatment (control) fluoride application alone, laser irradiation alone, laser irradiation after fluoride application, and fluoride application after laser irradiation. And each group was subdivided based on the application time of 1.23% acidulated phosphate fluoride (APF) (5 min and 30 min) and the irradiation energy of Nd:YAG laser ($20J/cm^2\;and\;40J/cm^2$). In case of fluoride application, each group was divided according to KOH treatment. Twenty three treatment conditions were made for this experiment and twelve specimens were assigned to each treatment condition. In each treatment condition, ten specimens were used for chemical analysis and two specimens were observed under SEM. In groups without treating KOH, fluoride content and the depth of enamel dissolved were measured using enamel biopsy technique. In groups with treating KOH, the amount of calcium fluoride was measured by the treatment with 1 M KOH for 24 hours and enamel biopsy was performed after KOH treatment. The results were analyzed by the fluoride content and the depth of enamel dissolved by enamel biopsy, amount and thickness of calcium fluoride, and the surface structures of enamel. The results are as follows: 1. In groups without treating KOH, the fluoride content of removed enamel showed a positive relationship with the energy density of laser when the laser irradiated before fluoride application 2. In groups without treating KOH, the depth of enamel dissolved decreased more with the combined laser and fluoride treatment than with laser or fluoride treatment, except for the case of $20J/cm^2$ laser irradiation after 5 minute fluoride application (p<0.05). 3. The amount of calcium fluoride did not increased by laser treatment with no statistical significance(p>0.05). 4. The particle size of calcium fluoride increased in case of fluoride treatment after laser irradiation, compared with fluoride application alone. In case of laser treatment after fluoride application, the particle size of calcium fluoride increased and some of the particles fused as well. 5. There were no significant differences in the fluoride content of dissolved enamel between groups without treating KOH and control group, except for the case of laser irradiation after treatment of APF for 30 minutes (p>0.05). 6. In groups with treating KOH, depth of removed enamel in the groups of combined treatment with laser and fluoride was shallower than that in fluoride application groups (p<0.05). 7. In groups without treating KOH, the relationship between fluoride content and the depth of enamel dissolved showed more negative (Spearman correlation coefficient: -0.6281) than in groups with treating KOH (Spearman correlation coefficient: -0.3792). The greater amount of calcium fluoride could be found in case where there was a significant differences of the depth of enamel dissolved between groups with and without treating KOH. From these results, it can be concluded that laser seems to be a little effects on the amount of calcium fluoride formation, but has some effect on the lowering the solubility of calcium fluoride. As the combined treatment of laser and fluoride application showed more effective acid-resistant property, more extended recall period for fluoride application can be achieved with this combined treatment in the clinic.

• Tuberculosis and Respiratory Diseases
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• v.57 no.5
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• pp.449-460
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• 2004

Background : PS-341 is a novel, highly selective and potent proteasome inhibitor, which showed cytotoxicity against some tumor cells. Its anti-tumor activity has been suggested to be associated with modulation of the expression of apoptosis-associated proteins, such as p53, $p21^{WAF/CIP1}$, $p27^{KIP1}$, NF-${\kappa}B$, Bax and Bcl-2. c-Jun N-terminal kinase (JNK) and glycogen synthase kinase-$3{\beta}$ (GSK-$3{\beta}$) are important modulators of apoptosis. However, their role in PS-341-induced apoptosis is unclear. This study was undertaken to elucidate the role of JNK and GSK-$3{\beta}$ in the PS-341-induced apoptosis in lung cancer cells. Method : NCI-H157 and A549 cells were used in the experiments. The cell viability was assayed using the MTT assay and apoptosis was evaluated by proteolysis of PARP. The JNK activity was measured by an in vitro immuno complex kinase assay and by phosphorylation of endogenous c-Jun. The protein expression was evaluated by Western blot analysis. Dominant negative JNK1 (DN-JNK1) and GSK-$3{\beta}$ were overexpressed using plasmid and adenovirus vectors, respectively. Result : PS-341 reduced the cell viability via apoptosis, activated JNK and increased the c-Jun expression. Blocking of the JNK activation by overexpression of DN-JNK1, or pretreatment with SP600125, suppressed the apoptosis induced by PS-341. The activation of caspase 3 was mediated by JNK activation. Blocking of the caspase 3 activation suppressed PS-341-induced apoptosis. PS-341 activated the phosphatidylinositol 3-kinase (PI3K)/Akt pathway, but its blockade enhanced the PS-341-induced cell death via apoptosis. GSK-$3{\beta}$ was inactivated by PS-341 via the PI3K/Akt pathway. Overexpression of constitutively active GSK-$3{\beta}$ enhanced PS-341-induced apoptosis; in contrast, this was suppressed by dominant negative GSK-$3{\beta}$ (DN-GSK-$3{\beta}$). Inactivation of GSK-$3{\beta}$ by pretreatment with lithium chloride or the overexpression of DN-GSK-$3{\beta}$ suppressed both the JNK activation and c-Jun up-regulation induced by PS-341. Conclusion : The JNK/caspase pathway is involved in PS-341-induced apoptosis, which is negatively regulated by the PI3K/Akt-mediated inactivation of GSK-$3{\beta}$ in lung cancer cells.

• The Korean Journal of Nuclear Medicine Technology
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• v.16 no.1
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• pp.57-61
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• 2012

Purpose: The multi-gated cardiac blood pool scan is to evaluate the function of left ventricle (LV) and usefully observe a value of ejection fraction (EF) for a patient who is receiving chemotherapy. To calculate LVEF, we should adjust an angle of left anterior oblique (LAO) view to separate both ventricles. And by overlapped ventricles, it is possible to affect LVEF. The purpose of this study is to investigate and compare quantitative indices by changing an angle of LAO view. Materials and methods: We analyzed the 49 patients who were examined by multi-gated cardiac blood pool scan in department of nuclear medicine at Asan Medical Center from June to September 2011. Firstly, we acquired "Best septal" view. And then, we got images by addition and subtraction of angle for LAO view to anterior and lateral. We compared three LAO views for 20 people by 5 degrees and 39 people by 10 degrees. And we analyzed quantitative indices, EF, end diastole and end systole counts, by automated and manual region of interest (ROI) modes. Results: Firstly, we analyzed quantitative indices by automated ROI mode. In case of 5 degrees, the averages of EF are $61.0{\pm}7.5$, $62.1{\pm}7.1$, $60.9{\pm}6.7%$ ($p$=0.841) in LAO, LAO $-5^{\circ}$ and LAO $+5^{\circ}$ respectively. And there is no difference in end diastole and end systole counts ($p$<0.05). In case of 10 degrees, the averages of EF are $62.4{\pm}9.5$, $62.3{\pm}10.8$, $61.6{\pm}.9.3%$ ($p$=0.938) in LAO, LAO $-10^{\circ}$ and LAO $+10^{\circ}$ respectively. And there is no difference in end diastole and end systole counts ($p$<0.05). Secondly, we analyzed quantitative indices by manual ROI mode. In case of 5 degrees, the averages of EF are $62.8{\pm}7.1$, $63.6{\pm}7.5$, $62.7{\pm}7.3%$ ($p$=0.903) in LAO, LAO $-5^{\circ}$ and LAO $+5^{\circ}$ respectively. And there is no difference in end diastole and end systole counts ($p$<0.05). In case of 10 degrees, the averages of EF are $65.5{\pm}9.0$, $66.3{\pm}8.7$, $63.5{\pm}.9.3%$ (p=0.473) in LAO, LAO $-10^{\circ}$ and LAO $+10^{\circ}$ respectively. And there is no difference in end diastole and end systole counts ($p$<0.05). Conclusion: When an image is nearly "Best septal" view, the difference of LAO angle would not affect to change LVEF. Although there was no difference in quantitative analysis, deviations could happen when to interpret wall motion qualitatively by reading physicians.

• The Korean Journal of Nuclear Medicine Technology
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• v.16 no.1
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• pp.17-26
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• 2012

Purpose: This study mainly focuses on the patients treated with chemically stable radiopharmaceutical product $^{99m}Tc$-HMPAO (d,l-hexamethylpropylene amine oxime) which yielded reduced image quality due to a decreased brain extraction rate. $^{99m}Tc$-HMPAO will be examined further to determine whether this product may be accounted as a factor for this cause. Material and Methods: From January 2010 until December 2010, out of 272 patients who were all subjected to $^{99m}Tc$-HMPAO brain blood flow SPECT scans resulting from Cerebral Infarction; 23 patients(ages $55.3{\pm}9$, 21 males, 3 females) with decreased tissue extraction rate were examined in detail. The radiopharmaceutical product $^{99m}Tc$-HMPAO was used on patients with normal brain tissue exchange rate as well as those with reduced rate in order to prove its' chemical stability. The patients' age, sex, blood pressure, existence of diabetes, drug use, current health status, known side effects from CT/MRI, examination of the patients' past SPECT before/after images were accounted to determine the factors and correlations affecting the rate of blood tissue extractions. Result: After multiple linear regression analysis, there were no unusual correlations between the 6 factors excluding sex, and before/after examination images. Male subjects showed reduced brain tissue extraction rate than the females ($p$ > 0.05) 91.3% male, 8.7% female. Wilcoxon Matched-Pairs Signed-Ranks Test was used on the before/after images which yielded a value of 0.06, which did not indicate a significant amount of difference on the 2 tests ($p$ > 0.05). As a result, the before/after images indicated similar brain tissue extraction rates, and there were variations depending on the individual patient. Conclusion: The effects of the chemically stable radiopharmaceutical product $^{99m}Tc$-HMPAO depended on the patient's personal characteristics and status, therefore was considered to be a factor in reducing brain tissue extraction rate. The related articles of $^{99m}Tc$-HMPAO cerebral blood flow SPECT speculates a cerebrovascular disease and factors resulting from portal veins, and it was not possible to pin point the exact cause of decreasing brain tissue extraction rate. However, the $^{99m}Tc$-HMPAO cerebral blood flow SPECT scan proved to be extremely useful in tracking and inspecting brain diseases, as well as offering accurate results from patients suffering from reduced brain tissue extraction rates.

• Childhood Kidney Diseases
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• v.8 no.2
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• pp.186-194
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• 2004

Purpose: Membranoproliferative glomeulonephritis(MPGN) has been diagnosed in an increasing number of asymptomatic cases. These cases have been detected by school urinary screening test even though the total cases of MPGN show a decreasing trend. We have analyzed the clinical and pathological characteristics of children with MPGN according to the clinical manifestations at the time of disease presentation. Methods: A total of 18 patients who had been diagnosed with idiopathic MPGN by percutaneous renal biopsy from January 1990 to February 2004 were involved in our study. The patients were divided into 2 groups as the school urinary screening(A) group and the symptomatic(S) group according to the clinical manifestations at the time of disease presentation. Results: Out of the total 18 patients, 8(44.4%) were in the S group and 10(55.6%) were in the A group. The mean serum total protein, albumin and $C_3$ levels in the S group were significantly lower than those levels of the A group, respectively($4.9{\pm}1.2\;g/dL,\;vs\;7.0{\pm}0.5\;g/dL\;P=0.002,\;2.8{\pm}0.9\;g/dL\;vs.\;4.1{\pm}0.3\;g/dL\;P=0.002,\;63.9{\pm}36.4\;mg/dL\;vs.\;100.8{\pm}39.5\;g/dL\;P=0.041$). The mean total protein amount of 24 hour collected urine in the S group were significantly higher than that of the A group($3684.0{\pm}2601.3\;mg/m^2\;vs.\;559.4{\pm}4.6.9\;mg/m^2$, respectively, P=0.001). Hypocomplementemia was observed in 11(61.1%) out of 18 patients at the time of disease onset, 7(87.5%) in the S group and 4(40%) in the A group. However the hypocomplementemia was decreased in 6(33.3%) out of 18 patients at the time of final follow-up, 3(37.5%) in the S group and 3(30%) in the A group. According to the pathologic type, hypocomplementemia was observed 8 patients(61.5%) with type I disease, 1 patients (100%) with type II disease, 2 patients(50%) in type III disease at the disease onset, but 4 patients(30.8%) in type I disease, 1 patient(100%) in type II disease, 1 patient(33.3%) with type III disease at the time of last follow-up. The incidence of cellular crescent formation and tubular atropy. as observed on light microscopy, were higher in the S group compared to the A group. Mean grade of capillary wall thickening and, mesangial proliferation were significantly higher in the S group. Conclusion: MPGN, as diagnosed in patients with only asymptomatic urinary abnormalities, has been increasing, it is more frequent in asymptomatic patients than in patients with presenting symptoms. Our result suggests that MPGN should be considered in the renal biopsy diagnosis regardless of serum $C_3$ level when urinary abnormalities are found by school urinary screening test.

• Korean Security Journal
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• no.36
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• pp.93-109
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• 2013

This research is mainly based on the experimental result due to seek different outcomes whena certain security motion with a paticular gear is applied in a plausible confrontational situation. For the purpose of this research an Expandable Baton, which is one of the most commonsecurity equipments, was chosen to be applied in a situation of hitting a person's head. Alsothe results will be studied in the view of Kinematic theory. To demonstrate, 10 students who were majeored in Escort Crane studies at 'H' university werechosen as testees. The participants were grouped into two-one is practiced with the 'expanadable baton use program' and the other is pre-practiced. In this report two groups abovewill be reffered as 'group A' and 'group B' for conveniency. There were a number of differences and changes between two groups. Group B took more timethan the other group did. Group A spent about 0.428sec in section 'e2' and 0.230sec in section'e3' while Group B took 0.435sec, 0.232sec in each sections.To add on, more distinctive results were out when it was more focused on physical movements. Two gropus presented considerable changes- in an 'left-right' moving displacement-Group A;$2.16{\pm}0.9cm$ (left side), $3.78{\pm}1.42cm$ (right side), total $5.94{\pm}2.03cm$. Group B; $2.97{\pm}1.01cm$ (left side),$4.56{\pm}1.57cm$ (right side), total $7.53{\pm}2.13cm$.Continuously, different outcomeswere shown between two groups in a 'back and forth' moving displacement-Group A;$32.48{\pm}3.86cm$, $35.21{\pm}4.64cm$, total $69.36{\pm}5.72$. Group B; $34.50{\pm}6.12cm$, $37.04{\pm}3.70cm$, total $71.46{\pm}7.17cm$. Furthermore, changes in an 'up and down' moving displacement were - GroupA; $5.62{\pm}2.41cm$, $4.54{\pm}1.87cm$, total $10.11{\pm}1.57cm$. Group B; $6.33{\pm}1.78cm$, $4.86{\pm}1.85cm$,total $10.68{\pm}1.81cm$. To continue, there were few modifications of degree on participants' joints, espcially on 'Wristjoint', 'Elbow joint' and 'Shoulder joint', depend on different sections -Wrist joint;Group A; e1 $114.62{\pm}7.13$, e2 $68.27{\pm}6.37$, e3 $131.64{\pm}6.27$. Group B; e1 $112.62{\pm}6.13$, e2 $66.28{\pm}7.38$, e3$137.42{\pm}4.28$ and Elbow joint ; Group A e1 $132.31{\pm}6.55$, e2 $117.92{\pm}8.42$, e3 $144.41{\pm}6.32$. Group B; e1 $133.58{\pm}8.56$, e2 $114.45{\pm}8.21$, e3 $139.89{\pm}4.38$. Lastly, degree changes ofshoulder joint were; Group A; e1 $13.55{\pm}3.85$, e2 $131.42{\pm}11.24$, e3 $78.32{\pm}6.28$. Group B; e1$9.45{\pm}1.23$, e2 $136.74{\pm}13.21$, e3 $79.75{\pm}4.24$.

• The Korean Journal of Nuclear Medicine
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• v.32 no.6
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• pp.516-524
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• 1998

Purpose: Radiolabeled CEA79.4 antibody has a possibility to be used in radioimmunoscintigraphy or radioimmunotherapy of cancer. We investigated the in vitro properties and biodistribution of CEA79.4 antibody labeled with Re-188 or Tc-99m. Materials and Methods: CEA79.4 was reduced by 2-mercaptoethanol to produce-SH residue, and was labeled with Re-188 or Tc-99m. For direct labeling of Tc-99m, methylene-diphosphonate was used as transchelating agent. CEA79.4 in 50 mM Acetate Buffered Saline (ABS, pH 5.3) was labeled with Re-188, using stannous tartrate as reducing agent. In order to measure immunoreactivity and the affinity constant of radiolabeled antibody, cell binding assay and Scatchard analysis using human colon cancer cells SNU-C4, were performed. Biodistribution study of labeled CEA79.4 was carried out at 1, 14 and 24 hr in ICR mice. Results: Labeling efficiencies of Tc-99m and Re-188 labeled antibodies were $92.4{\pm}5.9%$ and $84.7{\pm}4.6%$, respectively, In vitro stability of Tc-99m-CEA79.4 in human serum was higher than Re-188-CEA79.4. Immunoreactivity and affinity constant of Tc-99m-CEA79.4 were 59.2% and $6.59{\times}10^9\;M^{-1}$, respectively, while those of Re-188-CEA79.4 were 41.6% and $4.2{\times}10^9\;M^{-1}$, respectively. After 24 hr of administrations of Re-188 and Tc-99m labeled antibody, the remaining antibodies in blood were 6.32 and 9.35% ID/g respectively. The biodistribution of each labeled antibody in other organs was similar because they did not accumulate in non-targeted organs. Conclusion: In vitro properties and biodistribution of Re-188-CEA79.4 were similar to those of Tc-99m-CEA79.4. It appears that Re-188-CEA79.4 can be used as a suitable agent for radioimmunotheraphy.

• Journal of agricultural medicine and community health
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• v.35 no.3
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• pp.260-273
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• 2010

Objectives: The purpose of this study was to investigate the perceptions of married Korean women regarding marriage and childbirth, and their awareness of childbirth-related issues such as low birth rates, sex preferences and sex imbalances in Korea. Methods: A total of 453 married women aged 20 or older were randomly selected from four urban districts and five rural districts out of 25 districts in Gyeongju, a consolidated city located in Gyeongsangbuk-do Province, South Korea. The survey was conducted from December 2005 to February 2006. A total of 392 out of 453 questionnaires(86.5% response rate) were collected, and 44 incomplete questionnaires were excluded, leaving 348 completed questionnaires to be used for data analysis. Age was divided into three groups as below 49, 50-69, 70 or older. Results: Women's perceptions of marriage were associated with age(p<0.01). Perceptions about childbirth were also significantly related to age(p<0.01), type of residential area (p<0.01) and education level(p<0.05). Sex preferences were significantly related to age(p<0.05) and occupation(p<0.01). Of the respondents aged 49 or younger, 34.8% indicated that the ideal number of children is two, while 25.5% of respondents aged 50 to 69 and 15.3% of respondents aged 70 and 33.7% of respondents aged 70 or older considered four children to be the ideal number. Perceptions of sex imbalance were significantly related to socioeconomic status(p<0.01) and occupation(p<0.01). The largest number of respondents cited "economic burden" as the main reason for low birth rates. Multiple logistic regressions were performed for all three age groups using male sex preference as the dependent variable under the assumption that respondents can have only a single child. Socioeconomic status (p<0.01) and residential area (p<0.05) were significant variables for those aged 49 or below. Education level(p<0.05) and residential area (p<0.01) were statistically significant variables on preferring son in case of having only one child for respondents aged 50 to 69. We did not detect any significant independent variables in respondents who were 70 or older. Conclusions: Our results highlight the necessity of developing policies and public education programs to explain the consequences of low birth rates and sex imbalances in Korea. As increasing numbers of women work outside the home, it is important for the government and employers to provide social and working environments where women do not consider marriage and childbirth to be obstacles to social and business activities.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.1 no.1
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• pp.45-55
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• 1998

Purpose: To make objective standards of small intestinal mucosal changes in cow's milk-sensitive enteropathy (CMSE) we analyzed histological changes of endoscopic duodenal mucosa biopsy specimens from normal children and patients of CMSE. Methods: We review the medical records of patients who had been admitted and diagnosed as CMSE by means of gastrofiberscopic duodenal mucosal biopsy following cow's milk challenge and withdrawal. Thirteen babies with CMSE, ranging from 14 days to 56 days of age, were studied. Five non-CMSE patients were used as control, ranging from 22 days to 72 days of age. The morphometric parameters under study were villous height, crypt zone depth, ratio of villous height to crypt zone depth, total mucosal thickness and length of surface epithelium by using H & E stained specimens under the drawing apparatus attached microscope. In addition, the numbers of lymphocytes in the epithelium and eosinophil cells in the lamina propria and epithelium were measured. Results: In the duodenal mucosal biopsy specimens in CMSE we found partial and subtotal villous atrophy with an increased number of interepithelial lymphocytes. The mean villous height($135{\pm}59\;{\mu}m$), ratio of villous height to crypt zone depth ($0.46{\pm}0.28$), total mucosal thickness ($499{\pm}56\;{\mu}m$), length of surface epithelium of small intestinal mucosa ($889{\pm}231\;{\mu}m$) in CMSE was significantly decreased compared with the control (p<0.05). The mean crypt zone depth ($311{\pm}65\;{\mu}m$) was significantly greater than the control ($188{\pm}24\;{\mu}m$)(p<0.05). Infiltration of interepithelial lymphocytes ($34.1{\pm}10.5$) were significantly greater than the control ($13.6{\pm}3.6$)(p<0.05). The number of eosinophil cells in both lamina propria and epithelium was no significant differences between groups (p>0.05). The small intestinal mucosa in treated CMSE showed much improved enteropathy of villous height, crypt zone depth, interepithelial lymphocytes compared with the control as well as untreated CMSE. Conclusion: Quantitation of mucosal dimensions confirmed the presence of CMSE. It seems to be a limitation in the capacity of crypt cells to compensate for the loss of villous epithelium in CMSE. Specimens obtained by gastrofiberscopic duodenal mucosal biopsy were suitable for morphometric diagnosis of CMSE. Improvement of CMSE also can be confirmed histologically after the therapy of protein hydrolysate.