• The Journal of the Korean life insurance medical association
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• v.22
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• pp.55-98
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• 2003

본 연구는 질병별사망율연구(疾病別死亡率硏究)의 이론적 기초를 제시하고 일본 선진보험사의 질병별사망율연구(疾病別死亡率硏究)의 경험을 고찰하고 국내 보험사들의 질병사망율연관데이터의 현황분석을 통해 향후 질병별사망율연구(疾病別死亡率硏究)의 결과를 얻기 위해 현재 보험사들이 전사적으로 준비하여야 할 것에 대해 제언을 하고자 한다. 사망률연구(mortality study)란 인구통계학적 개념을 기본으로 하여 역학적 연구방법의 하나인 코호트방법과 생존분석방법을 결합하여 인구집단(또는 피보험자 집단)을 대상으로 대량의 자료를 장기적으로 관찰하여 그 사망의 빈도와 분포를 기술하고 사망연관지수들을 알아내어 생명보험사업에 있어서 위험선택기술을 향상시키는 것이다. 초과사망을 및 사망비 산출의 실제를 생명표 방법론과 급성심근 경색증 환자의 생존 분석을 통해 알아본다. 생명표 방법론을 이용한 생존 분석방법이란 의학저널에서 발표된 논문을 사망률표로 변경하기 위한 필수적인 단계에 대한 것이다 관찰된 생존 곡선을 생명표 작성법의 한 방법인 비교 경험 사망률로 바꾸는데 초점을 두었다. 일본생명(日本生命)의 경우, 일본 협영생명(協塋生命)의 경우, 일본사망율조사(MA)위원회 생명보험사망을 연구고서등을 통해 질병별사망율연구(疾病別死亡率硏究)를 살펴 보았다. 일본은 질병별사망율(疾病別死亡率)을 구하기 위해서 1950년대 이후부터 체계적으로 자료를 모으고 축적, 분석하여 지속성을 유지하였다. 또한 일본MA위원회의 경우처럼 보험의학의사, 계리, 통계, 전산부서로 구성된 전담위원회의 통일된 협조가 질병별사망율연구(疾病別死亡率硏究)를 가능하게 하였다. 그리고 의학적인 관점에서 볼 때 일본보험의학계는 일본만의 독특한 질병분류로 분석하여 온 것이 특이하다. 질병별사망율연구(疾病別死亡率硏究)에 대해서는 모두가 필요성을 인정하면서도 구체적인 대비책은 없는 것이 우리나라 보험업계의 실정이다. 이러한 현실의 직접적인 이유는 질병별사망율연구(疾病別死亡率硏究)라는 것이 그 특성상 중장기적인 계획이며 많은 전문인력의 통합되고 집중된 노력이 요구되기 때문이다. 우리도 "생명보험사사망율연구위원회(Life Insurance Mortality Committee" (가칭)를 설치하고 장기적인 계획안을 먼저 만드는 것이 선행되어야 할 것이다. 지금부터 질병별사망율(疾病別死亡率) 데이터를 축적하고 매 5년 또는 매 10년마다 데이터를 분석한다면 질병별사망율(疾病別死亡率)에 대해 고유의 기술을 습득하는 것이 그리 먼 미래의 일만은 아닐 것이다.

• Journal of Chest Surgery
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• v.37 no.2
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• pp.146-153
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• 2004

As the experience of coronary artery bypass grafting (CABG) has been accumulated, the number of reoperation after CABG is increasing. We analyzed our clinical experience of redo-CABG. Material and Method: Fourteen patients who underwent redo-CABG between Jan. 1994 and Dec. 2002 were included in this study. The mean period from the first operation to reoperation was 66$\pm$56 (3∼157) months, and the average ages were 62.8$\pm$8.7 (51∼78) years. The survivors were followed up 39$\pm$29 (4∼101) months postoperatively. Indications of reoperation were stenosis or occlusion of previous grafts in 11 patients, progression of native coronary artery disease in one patient, and both etiologies in two patients. Result: There were two in-hospital mortalities (14.3%) resulting from low cardiac output syndrome, Postoperative morbidities were perioperative myocardiac infarction in 2 patients (14.3%), mediastinitis in one patient (7.2%), duodenal perforation in one patient, ischemic necrosis of the lower extremity in one patient, gastric perforation after mesenteric infarct in one patient, delayed brain infarct in one patient, and intraoperative splenic rupture in one patient. There was one late mortality at six months postoperatively during the follow up. There was no angina recurrence during the follow up. Conclusion: Although redo CABG demonstrated relatively high operative mortalities and morbidities, postoperative status and clinical outcome of the survivors were favorable.

• Journal of Chest Surgery
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• v.37 no.7
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• pp.553-558
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• 2004

Avoiding cardiopulmonary bypass (CPB) in coronary artery bypass grafting (CAB G) has been known to reduce early mortality and morbidity. Diabetes Mellitus is a significant risk factor for adverse early and late outcomes after CABG. We compared the clinical results of off-pump CABG versus on-pump CABG in diabetes patients. Material and Method: 682 patients (424 off-pump CABG and 258 on-pump CABG) underwent isolated coronary artery bypass grafting between January 2001 and June 2003. Data were collected 242 patient who had diabetes. Among them, 154 patients underwent off-pump CABG and 90 patients underwent on-pump CABG. We analyzed the preoperative risk factors and postoperative results between 2 groups. Result: Two groups did not show statistical differences in age, sex, coronary and operative risk factors. Operative time was significantly shorter in off-pump CABG, however, number of grafts was fewer in off-pump CABG. Postoperative inotropic usage was lower in off-pump CABG. Postoperative CK-MB level was lower in off-pump CABG, and ICU stay and ventilation time was significantly shorter in off-pump CABG. However, there was no statistical difference between 2 groups in operative mortality, reoperation rate, perioperative myocardial infarction, wound infection, renal failure, neurological complications and hospital stay. Conclusion: Off-pump CABG group showed less myocardial damage and early recovery. We concluded that off-pump CABG is the more reasonable technique in diabetes patients although two techniques showed good results. The long-term follow up and prospective study may be warranted.

• Journal of Life Science
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• v.9 no.2
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• pp.231-240
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• 1999

Regular exercise is effective in preventing coronary disease such as angina pectoris and infarction, inside it can lower the blood pressure and aids in weight control and release of stress. Risk factors of arteriosclerosis is hypertension, hyperlipidemia, diabetes, obesity, physical inactivity and excessive smoking. Arteriosclerosis begins at young age worsens with age, particulary in male. For people with risk factors of arteriosclerosis, it is important to prevent arteriosclerosis-related disease with dietary, living pattern and exercise prescription. Dietary fibers promote exercise of the digestive tract and shortens the time food remains inside the digestive tract. It can prevent obesity, hyperlipidemia, arteriosclerosis and colin cancer by blocking the absorption of cholesterol. Various vegetables and sea foods are lichen unsaturated fats and prevent the absorption of cholesterol inside the digestive tract. Essential fatty acids and unsaturated fats which are contained in vegetable oils, promotes metabolism while preventing absorption. In fruits, pectin water-soluble fiber, is present and lowers the level of cholesterol. By consuming foods that low in cholesterol and saturated fats, and rich in unsaturated fats, aliomentotherapy alone can reduce the plasma cholesterol by 10~l5$\%$. For ideal exercise, it should be aerobic with intensity of 60~80$\%$ HRmax, duration of 15~60min/day. The frequancy of 3~6/week is desirable the better exercise prescription is endurance aerobic exercise. To get more effect exercise, exercise consistency is very important.

• Korean Journal of Clinical Laboratory Science
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• v.51 no.1
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• pp.34-41
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• 2019

Platelet aggregation is essential for the formation of a hemostatic plug in the case of blood vessel damage. On the other hand, excessive platelet aggregation may cause cardiovascular disorders, such as thrombosis, atherosclerosis, and myocardial infarction. Scopoletin, which found in the root of plants in the genus Scopolia or Artemisia, has anti-coagulation and anti-malaria effects. This study examined the effects of scopoletin on human platelet aggregation induced by collagen. Scopoletin had anti-platelet effects via the down-regulation of thromboxane $A_2$ ($TXA_2$) production and intracellular $Ca^{2+}$ mobilization ($[Ca^{2+}]_i$), which are aggregation-inducing molecules produced in activated platelets. On the other hand, scopoletin increased both the cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) levels, which are known as intracellular $Ca^{2+}$-antagonists and aggregation-inhibiting molecules. In particular, scopoletin increased the potently cAMP level more than cGMP, which led to suppressed fibrinogen binding to ${\alpha}IIb/{\beta}_3$ in collagen-induced human platelet aggregation. In addition, scopoletin inhibited collagen-elevated adenosine triphosphate (ATP) release in a dose-dependent manner. The results suggest that aggregation amplification through granule secretion is inhibited by scopoletin. Therefore, scopoletin has potent anti-platelet effects and may have potential for the prevention of platelet-derived vascular diseases.

• Journal of the Korean Society of Radiology
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• v.14 no.3
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• pp.319-336
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• 2020

The purpose of this study was to compare the outcomes of two interventional methods, overlapping drug-eluting stents (DES) and long DES, for long-term clinical outcomes in patients with acute myocardial infarction (AMI). A total of 438 patients with AMI (65.9±11.0 years, 306 males) from June 2008 to March 2019 who had diffuse long coronary artery lesion, more than 30mm were divided into two groups; group I (overlapped DES group; n=140) and group II (long DES group; n=298). We compared the incidences of major adverse cardiac events [MACEs; cardiac death, myocardial infaction (MI), target lesion revascularization (TLR) and stent thrombosis (ST)] during 12 months between the two groups. Everolimus-eluting stent was more commonly used in group II than in group I (28.1% vs. 51.8% p<0.001). Mean lesion diameter was slightly longer in group II (3.1±0.3mm vs. 3.2±0.3mm, p=0.042), and prevalence of ACC/AHA lesion type C was higher in group I (41.7% vs. 25.4%, p<0.001). Incidences of MACEs during 12 months were higher in group I than group II (18.5% vs. 14.4%, p=0.034). The rates of cardiac death (2.1% vs. 4.4%, p=0.667), MI (5.0% vs. 2.7%, p=0.260) and stent thrombosis rate (0.7% vs. 1.7%, p=0.669) were similar between the two groups. However, TLR rate was higher in group I (10.7% vs. 5.6%, p=0.041). In multivariate logistic regression analysis, presence of diabetes mellitus [Hazard ratio (HR) 2.383, 95% confidence interval (CI) 1.332-4.260, p=0.003] and use of paclitaxel-eluting stent (HR) 2.367, 95% CI 1.371-4.086, p=0.002) were independent predictors of 12-month MACEs, without significant differences in prevalence between the two groups. In AMI patients with diffuse long lesion, TLR rate was higher in the overlapped DES group during 12-month follow-up. Presence of diabetes and use of paclitaxel-eluting stent were independent predictors of MACEs.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.685-692
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• 2005

Background: Wall motion abnormalities may be a significant predictor for long-term survival after coronary bypass surgery (CABG). The aim of this study is to see whether post-infarction wall motion abnormality of left ventricle affect on the long-term survival after CABG. Material and Method: One-hundred and thirty-three patients (male/female, 92/41) undergoing CABG more than 9 years ago were included in this study. Fifty-six patients (M/F, 42/14; mean age, $59.2\pm9.2$ years) with LV wall motion abnormalities were compared to 77 patients (M/F, 50/27; mean age, $58.0\pm7.6$ years) without the wall motion abnormalities. Most patients (112/133, $84.2\%$) had undergone on-pump CABG with the in-situ left internal thoracic artery and free grafts of saphenous vein, in which the proximal and distal anastomoses were done for the single aortic cross-clamping period. Result: Ejection fraction of left ventricle was lower in the group with LV wall motion abnormalities (mean ejection fraction, $48.7\pm13.2\%$) compared to the group without wall motion abnormalities (mean ejection fraction, $57.1\pm10.1\%$)(p=0.0001). Risk­unadjusted survivals after CABG in the group without wall motion abnormalities were $85.7\pm4.0\%,\;76.2\pm4.9\%,\;and\;57.2\pm10.3\%$ at 5, 10, and 13 years, respectively, and in the group with wall motion abnormalities were $80.4\pm5.3\%,\;58.7\pm7.3\%,\;and\;51.9\pm7.9\%$ at 5, 10, and 13 years, respectively (p=0.1). In univariate analysis, predictable factors of long-term survival in the patients with LV wall motion abnormalities were LV ejection fraction and post operative outpatient treatment. In multivariate analysis, predictable factor of long-term survival in the patients with the wall motion abnormalities was postoperative outpatient treatment, and that in those without the wall motion abnormalities was female. Conclusion: Although there was no significant survival difference after CABG between the group with LV wall motion abnormalities and that without wall motion abnormalities, the survival in the group with wall motion abnormalities seems to be more decreased. For the patients with LV wall motion abnormalities after myocardial infarction, the post-CABG outpatient treatment is suggested to be an important factor for the long-term survival.

• Journal of Chest Surgery
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• v.39 no.7 s.264
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• pp.544-548
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• 2006

Background: The purpose of this study is to evaluate the validity of a combined high saphenous vein division and sclerotherapy without sacrificing saphenous vein for varicose vein. Material and Method: Between August 2004 and October 2005, 70 limbs in 50 patients were treated by a combined high saphenous vein division and sclero-therapy. The operative indication is valvular incompetence of femoral-saphenous or popliteal-saphenous junction. Patients received local anesthesia and were treated by a combined high saphenous vein division, ligation of incompetent perforating vein and $1{\sim}3%$ sclerosant. Patients received 1 day hospitalization and applied in com-pression stocking for 6 weeks. Patients followed after 1 week, 1 and 3 months. Result: Mean age of patients was $50{\pm}11$. The female was more common. 8 patients was no symptom, another 42 patients complained of pain, heaviness and fatigue of limbs. The symptoms of varicose vein disappeared 1 month after the procedure in all symptomatic patients. 8 patients needed a adjuvant sclerotherapy for residual varicose vein on 1 week after the procedure. There were only minor complications such as hematoma (1), wound infection (1), thrombophlebitis (20), skin blister (10), hyper-pigmentation (1), and skin ulcer (1). Conclusion: We concluded that a combined high saphenous vein division and sclerotherapy without sacrificing saphenous vein for varicose vein is simple, less invasive, economical, and effective treatment for primary varicose vein, and it has a special advantage that saphenous vein can be used as a bypass conduit later. The method was selective in old aged patients.

• Journal of Chest Surgery
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• v.35 no.4
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• pp.261-266
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• 2002

In an attempt to avoid the adverse effects of the cardiopulmonary bypass, off pump coronary artery bypass grafting(Off pump CABG) that has recently been rediscovered and refined. We compared the preoperative risk factors and in-hospital outcomes of patients done Off pump with those done On pump CABG. Material na Method: One hundred seventy eight patients was underwent CABG between January 2001 and July 2001 12 patients whom underwent associated valvular or left ventricular volume reduction surgery were excluded in this study Data were collected for 52 Off pump CABG and 114 On pump CABG for patient and disease risk factors, extent of coronary disease, and in-hospital outcomes. Result: Off pump CABG and On pump CABG groups did not show any differences in their patient and disease risk factors, and extent of coronary disease. Off pump CABG group had significantly lower mean operation time(234 $\pm$ 37 min vs 290 $\pm$ 48 min, p<0.001), lower mean CK-MB level(10.1 $\pm$ 13.5 IU/L vs 33.1 $\pm$ 18.2 IU/L, p<0.001) and mean ventilation time(14.8 $\pm$ 3.5 hours vs 16.2 $\pm$ 4.9 hours, p=0.048) than On pump CABG groups. On pump CABG group had significantly more distal grafts(3.4 $\pm$ 0.9 vs 2.6 $\pm$ 0.8, p<0.001) than Off pump CABG groups. There were no operative mortality in two groups. Off pump) CABG and On pump CABG groups did not show any differences in their postoperative complications and outcomes including perioperative myocardial infarction, stroke, respiratory failure, renal failure, reoperation, the amount of bleeding, the need of intraaortic balloon pump, the need of inotropics, and the stay of intensive care unit and hospital. Two patients were converted to On pump CABG. Conclusion: This study showed that patients having Off pump CABG are not exposed to a greater risks of adverse outcomes and also provided evidence that patients having Off pump CABG have significantly lower operation time, CK-MB, ventilation time and less distal grafts. Although there may be potential benefits to Off pump CABG, further studies must be directed to determine those patients who would benefit from Off pump CABG.

• Journal of Yeungnam Medical Science
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• v.13 no.2
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• pp.225-233
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• 1996

From August 1992 to July 1996, 63 consecutive patients underwent coronary artery bypass surgery. The mean age of these patient was 57 years(range form 30 to 71years). There were 44 men and 19 women. Preoperative 12 patients had stable angina pectoris and 23 patients were unstable angina pectoris. 8 patients had previous myocardial infarctation history and emergency or urgent myocardial revascularization were performed in 9 cases. In the risk factors of coronary atherosclerosis, 25 patients(40%) were hypercholesterolemia, 38 patients(60%) have smoking history and 19 patients(30%) have hypertension history. In the patterns of disease, 9 patients were single vessel disease, 18 patients were two vessele disease and 33 patients were three vessel disease. We performed total 284 distal anastomosis(mean 3.5 anastomosis per patient) and performed one case of ascending aorta graft interposition, two cases of mitral valve replacement, one case of aortic valve replacement, one case of ventricular septal defect repair and one case of atrial septal defect repair and the mean aortic cross clamp time was 115.3 minutes. The common complications were arrhythmia(7cases), wound infection(5cases), perioperative myocardial infarction(4cases), reoperation for bleeding control(4cases) and stroke(4cases). There were six hospital deaths due to low cardiac output syndrome, ventricular arrhythmia and respiratory failure. In the evaluation of operative risk factors, preoperative intravenous nitroglycerin requirement and prolonged aortic cross clamp tirne(>2hours) were found to be predective factor of morbidity and old age(>65years) was found to be predective factor of mortality.