• The Journal of the Korean life insurance medical association
• /
• v.25
• /
• pp.9-24
• /
• 2006

지속적으로 증가 하고 있는 악성 종양 발병률의 증가, 생존률의 향상, 조기발견의 증가 등이 암 기왕자의 보험 수요 상승을 가져오고 있으며, 보험시장에서 더 이상 암 기왕자를 도외시하기 어렵게 만들고 있다. 그러나, 현재 국내에서는 암 기왕자를 인수할 수 있는 상품과 언더라이팅 인수 기법이 부족한 실정이다. 본 논문은 이러한 상황 하에서 기존에 거절체로 인식되었던 암 기왕자의 적극적인 인수를 위해 악성종양에 대한 보험 의학적인 고찰과 사망률, 위험도에 대해 분석하고, 국내에서 암 기왕자의 보험 인수 시 문제점과 그 해결방안을 모색해 보았다. 종양은 종양세포의 성장과 확산의 정도를 나타내는 병기와 조직학적 등급에 의해 그 예후와 경과가 예측 가능하며, 이 병기를 표준화하려는 국제적 시도로 1977년 American Joint Committee on Cancer(AJCC)는 TNM system 을 제시하였다. 병기를 기초로 치료의 결정도 함께 이루어지는데, 주요 치료법을 수술, 방사선치료, 항암치료, 면역요법이 있다. 이러한 치료법들은 후기 부작용을 일으키거나 이차성 암(Secondary malignant neoplasm)의 원인이 되기도 한다. 병기에 따른 암환자의 사망률을 살펴 보면, 암은 일정시기 동안 사망률이 급격히 증가하다가 이후에 점차 사망률이 감소하고, 그 이후에는 사망률에 영향을 미치지 않는다. 이러한 사망률 변화의 특성은 암 기왕자에게 평준식 정액 할증법(Per mille flat extra)의 적용이 적절함을 보여준다. 그러나, 현재 국내에서는 악성 종양 기왕자를 위한 상품이 전무한 상태이며, 암의 병리적 병기와 치료에 관련된 정보를 얻을 수 있는 도구도 부족하고, 명확한 인수 기법이 없다. 또한, 자체의 경험통계의 부족으로 위험에 대한 부담감이 큰 것이 현실이다. 하지만, 병기에 따른 사망률의 변화에서도 알 수 있듯이 평준식 정액 할증법의 도입이나, 악성종양의 병기(Stage)별 정액 할증률을 삭감법으로 전환하는 기준을 개발한다면, 종신보험은 충분히 인수가 가능하다. 또한, CI 보험도 암에 대한 부담보를 하는 선진사의 인수 기법을 도입하거나, 암 기왕자만을 위한 CI 상품을 개발하는 등 새로운 인수 기법을 모색한다면, 암기왕자 인수의 폭은 넓어질 것이다. 이와 같은 노력과 함께, 언더라이팅의 정보 획득을 위한 암 기왕자만의 고지서를 개발하고, 전문 언더라이터의 양성을 위한 노력을 게을리 하지 않는다면, 암기왕자를 적극적으로 인수할 수 있을 것이다. 앞으로 국내 보험사가 위와 같은 노력을 지속적으로 해 나가고, 비교적 예후와 경과가 양호한 0기와 1기 암 기왕자부터 단계적으로 종신보험의 인수를 시도한다면, 비교적 안전하게 경험치를 축적할 수 있을 것이다. 뿐만 아니라 국내 보험업계는 새로운 시장의 확보와 보험에 대한 대외 이미지 개선이라는 효과도 함께 얻게 될 것이다.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.5
• /
• pp.650-658
• /
• 2000

Objective : To evaluate the role of Gamma Knife radiosurgery in essential and tumor-related(secondary) trigeminal neuralgia, outcomes of radiosurgery and microsurgery were compared each other. Methods : Five patients with essential trigeminal neuralgia underwent stereotactic radiosurgical treatment with Leksell Gamma Knife and twenty five patients were treated with microsurgery during the same period(1994. 1-1997. 6). A 4-mm collimator was used and REZ or proximal portion of trigeminal nerve was targeted with maximal dose of 60-72Gy. The mean follow-up after radiosurgery was 39.4 months and that after microsurgery was 47.9 months. Results : At the last follow-up, four patients(80%) had excellent(pain free) or good(50-90% pain relief) outcomes, one(20%) had poor control after radiosurgical treatment. Twenty-three patients(92%) had excellent or good outcomes and two(8%) had poor results after microsurgery. Postoperative complications occurred in ten(40%) with microsurgery, but there were no complications in patients with Gamma Knife radiosurgery. Six patients with secondary trigeminal neuralgia received radiosurgical treatment directed at their tumors, and three patients were surgically treated. Three of six(50%) patients treated with Gamma Knife had pain relief while two of three patients with surgical treatment showed immediate pain relief. Post-treatment complications were developed in two of six radiosurgical patients and in one of three surgical patients. Conclusion : Gamma Knife stereotactic radiosurgery may be considered as a useful and alternative option for the treatment of essential and secondary trigeminal neuralgia owing to of its safety and less complications. The preliminary results obtained in our series appear encouraging, although the outcome is not so good as that of surgery.

• The korean journal of orthodontics
• /
• v.34 no.6 s.107
• /
• pp.526-536
• /
• 2004

This study was undertaken to determine the effect of a 2.2mg/Kg/day intraoral administration of NaF on the amount of root resorption and osteoclastic activity during or after a rapid maxillary expansion procedure. Ten puerile female dogs were divided into two groups: a control group and a NaF-treated group. A fixed type maxillary expansion device was delivered to all dogs. The appliance was activated twice daily throughout a 20-day period, causing a 5-mm expansion of maxillary bone. After the expansion procedure, the animals were sacrificed at days 0, 15, 30, 45, and 60 of the retention period. The buccal surface of the root of each maxillary canine was examined by means of a surface electron microscope (SEM). Using SEM, web-like resorption lacunae were observed on the bone or the tooth surface at the site of osteoclastic activity; these observations were verified by histological methods. No peculiar resorption lacunae were found in the apical tip of the roots of either the control group or the NaF-treated group animals. The NaF-treated retention group was found to have less resorption lacunae formation on day 45 and day 60. The preventative effect of NaF on resorption lacunae formation on the surface of the bone covering the anchor tooth was confirmed. Larger areas of resorption lacunae were found on the surface of the bone covering the canines in the control group animals, as compared to those of the NaF-treated group, especially on day 30 and day 60. Using SEM, the present study revealed a difference between the control group and the NaF-treated group in the prevalence and the size of the resorption lacunae formation on the cemental root surface. The preventative effect of NaF on bone resorption was confirmed. Further studies concerned with the optimum concentration of NaF that has an effect in vivo are necessary.

• Radiation Oncology Journal
• /
• v.14 no.4
• /
• pp.339-345
• /
• 1996

Purpose : This study was performed for adequate irradiating tumor area when 6 MV linear accerelator photon was used to treat the head and neck tumor. The skin surface dose and maximum build-up region was measured by using a spoiler which was located between skin surface and collimator. Methods : A spoiler was made of tissue equivalent material and the skin surface dose and maximum build-up region was measured varing with field size, thickness of spoiler and interval between skin and collimator. The results of skin surface dose and maximum build-up dose was represented as a build-up ratio and it was compared with dose distribution by using a bolus. Results : The skin surface dose was increased with appling spoiler and decreased by distance of the skin-spoiler separation. The maxium build-up region was 1.5 cm below the skin surface and it was markedly decreased near the skin surface. By using a 1.0-cm thickness spoiler, Dmax moved to 5, 10.2, 12.3 13.9 and 14.8 mm from the skin surface by separation of the spoiler from the skin 0, 5, 10, 15. 20 cm, respectively. Conclusion : The skin surface dose was increased and maximum build-up region was moved to the surface by using a spoiler. Therefore spoiler was useful in treating by high energy photon in the head and neck tumor.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.37 no.3
• /
• pp.345-351
• /
• 2010

The purpose of this study is to compare microleakage and penetration depths of sealants applied in carious and sound fissures. Extracted premolars(n=80) were divided into 4 groups according to caries status. 1; sound, 2; stained, 3; initial caries, 4; enamel caries. Sealants were applied to the occlusal groove as per manufacturers' instructions, and specimens were thermocycled, stained, sectioned, and examined for microleakage and penetration ability. The results of the present study are as follow: 1. It showed significantly higher microleakage scores in group I than group Two, Three, Four(p<0.05), but no significant difference was found between group Two, Three, and IV(p>0.05). 2. It showed significantly higher penetration scores in group Four (p<0.05), followed by group One, Two, Three, but no significant difference was found between group One, Two, and Three(p>0.05). Based on the results of present study, when the borders of the fissure sealant are on carious enamel, a significantly higher microleakage must be expected. It is considered that depth of enamel caries in the fissure should be taken into account when applying a fissure sealant.

• Journal of Veterinary Clinics
• /
• v.30 no.3
• /
• pp.218-221
• /
• 2013

A flightless brown hawk owl (Ninox scutulata) weighing 180 g was rescued and referred to the teaching veterinary hospital with humerus open fracture. On physical examination and radiography, open fracture of the left humerus was found. After 3 days, orthopedic surgery was operated with intramedullary pins and wires. The bird died 2 days after surgery with anorexia. On necropsy, multiple green nodules with 2-3 mm in diameter were observed at the surface and inside of the left lung. Numerous conidial heads and spores were seen in the center of foci in the histopathological examination. The mycelia penetrated the surrounding pulmonary parenchyma, showing inflammation and necrosis. The fungus was isolated from the lung and cultured on Sabouraud Dextrose Agar at $30^{\circ}C$ for 7 days. The colony was blue-green color with a powdery surface. The fungus was identified as Aspergillus fumigatus by DNA analysis, including the internal transcribed spacer region, partial ${\beta}$-tubulin, and the calmodulin gene. This case was diagnosed as pulmonary aspergillosis secondary to open fracture of pneumatic bone in a brown hawk owl.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.29 no.3
• /
• pp.444-449
• /
• 2002

The term 'impaction' is used to designate a tooth which remains unerupted in the jaw beyond the time at which it should normally be erupted. The main causal factors are local (lack of space, ectopic positions of teeth, supernumerary teeth, cyst, the occurrence of infectious process in the eruption path, traumatic facial injury etc.). Systemic and genetic disorders, however, may have primary failure of eruption and retarded eruption as additional symptoms (cleidocranial dysplasia, osteopetrosis etc.). Most cases of impacted teeth reported in the literature are of permanent teeth. The absence of primary teeth occur rarely whereas impaction of second primary molars is more numerous than all other impactions. Impaction due to primary failure of eruption must be distinguished from the secondary infraocclusion. The etiology of impaction of primary teeth is probably related to early ankylosis of primary teeth, but it is not clear. Failure of eruption of primary teeth may cause a number of complications, such as interference with development and eruption of succedaneous teeth, formation of cyst, and damage to adjacent teeth. This study is to report cases of primary failure of eruption in the primary dentition.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.46 no.3
• /
• pp.310-317
• /
• 2019

The purpose of this retrospective study was to evaluate the survival rate of composite resin restorations in permanent first molars in pediatric patients focusing on the influence of risk factors related to patients and teeth. 172 patients (6 - 12 years old) who had their permanent first molars restored with composite resin from July 2010 to July 2012 were investigated. From the dental records, the influence of the risk factors on the survival of restorations was assessed. Location of teeth, classification of cavities, patients' age and caries risk were included as risk factors in this study. The caries risks of patients were evaluated by the value of the decayed-missing-filled teeth index with the records of patients taken at 5 years old. Among 354 restorations, 272 restorations retained and 82 restorations were replaced. The overall cumulative survival rate at 5 years was 73.9%. The main reason for replacement of restorations was secondary caries (81.7%). Patients with older age group and with lower caries risk group showed higher survival rate of restorations. No statistically significant influence was detected between the survival rates and the possible risk factors : location of teeth, patients' age and caries risk. The survival rate of restorations was significantly affected by the classification of the cavities (p = 0.002).

• The Journal of the Petrological Society of Korea
• /
• v.28 no.2
• /
• pp.129-141
• /
• 2019

The Eoraesan area, Chungju, which is located in the northwestern part of Ogcheon Metamorphic Zone, Korea, mainly consists of the Neoproterozoic Gyemyeongsan Formation and the Mesozoic igneous rocks which intruded it. The metaacidic rocks (MAR) of the Gyemyeongsan Formation show a maximum radioactive value, and the Early Jurassic biotite granite is regionally distributed in this area. In this paper is researched the microstructure related to the growth of rare-earth mineral of allanite in the MAR, and is considered the source and occurrence time of rare-earth element (REE) mineralization. The MAR is mainly composed of alkalic feldspar (mainly microcline), quartz, iron-oxidizing mineral, biotite, muscovite, plagioclase, hornblende, allanite, zircon, epidote, fluorite, apatite, garnet, (clino)zoisite etc. The radioactive elements contained in the allanite cause a dark brown hale in the surrounding biotite, and the allinte also occurs as aggregate along the regional foliation. The deflection of regional foliation and the strain shadows, which are common to the pre-tectonic porphyroblast grown before the formation of regional foliation, can't be observed around most allanites (aggregates). The grain size and orientation of ironoxidizing mineral included in the allanite aggregate are the same as those in the matrix. It is recognized the hydrothermal conversion of hornblende to biotite due to the intrusion of igneous rock, and the secondary biotite occurs and contacts with allanite, zircon, epidote etc. These microstructures indicate that the rare-earth mineral of allanite (aggregate) grew by the hydrothermal alteration due to the intrusion of igneous rock after the formation of regional foliation. It is considered that the REE mineralization is closely related to the intrusion of Early Jurassic biotite granite which is regionally distributed in this area.

• Tuberculosis and Respiratory Diseases
• /
• v.43 no.1
• /
• pp.14-21
• /
• 1996

Objectives: Although outbreak of MDR Tb has been a recent problem in western countries, it has been a longstanding problem in Korea. The poor outcome of MDR Tb is mainly due to poor compliance, high rate of side reaction of secondary drugs, and limitation in number of available drugs. Thus, to improve the outcome of MDR Tb, it is crucial to make individualized adequate prescription based on the knowledge of the patterns of resistance to each drugs in the community as well as the natural history. The purpose of present study is to evaluate the clinical features of Korean MDR Tb patients including patterns of drug resistance and success rate of treatment which was prescribed according to the sensitivity tests. Methods: Retroscpective analysis of 71 Korean patients with MDR Tb was made. All strains isolated from patients showed resistence to at least two first line drugs. Patients profile, previous treatment history, patterns of drug resistance, outcome of treatment was analysed. Initial treatment regimen was selected according to the previous treatment history and was modified according to the sensitivity reports. The regimen was composed to include at least 4 sensitive drugs when possible. Results: The patients showed resistance to 4.1 drugs on average. 90% of them were resistant to INH and RFP. Among 71 patients, 35 patients(49%) had cavitary lesions in CXR. Treatment outcome was analysed in 55 patients. 35 patients(67%) were improved after treatment and 18 patients(33%) showed treatment failure. 5 patients showed primary resistance. Treatment outcome could be evaluated in 4 of them and all showed improvement after treatment. 14 patients(20%) had to change their regimens due to drug side effects. The most frequent side effect was elevation of liver enzymes(6 patients). Others included dizziness, hyperuricemia, tinnitus, skin rash, GI troubles. More than 50% of side effects developed within 3 months. In repeated drug sensitivity test, the concordance rate of resistance to INH was 100% and RFP 98%. EMB, PZA showed 80% concordance rate. But in the other drugs, the concordances were less than 50%. Operation was done in 5 patient - 1 patients as a adjunctive means of chemotherapy -. In that case, negative conversion of sputum AFB was done. Conclusion: 2/3 patients of multidrug-resistant tuberculosis were improved by appropriate prescription and regular medication suggesting that more aggressive management and monitoring is indicated in multidrug-resistant tuberculosis.