• 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.

• Health Policy and Management
• /
• v.34 no.3
• /
• pp.282-292
• /
• 2024

Background: This study aimed to identify the relationship between regional health outcomes and the living population, which may reflect the characteristics of population migration in Seoul. Methods: This study used raw data on cause of death statistics from Statistics Korea's Micro Data Integration Service. To identify the independent variable, the living population, we used living population data provided by Korean Telecom for 25 districts of Seoul. The control variables were based on the four domains of SDoH (social determinants of health; economic stability, healthcare access and quality, neighborhood and built environment, and social and community context). Panel generalized estimating equations (GEE) analysis was used to determine the relationship between living population and regional health outcomes. Results: The panel GEE analysis showed that all mortality-related health outcomes (avoidable, preventable, and treatable mortality) had a statistically significant negative relationship with the living population. This indicated that an increase in living population had a positive effect on mortality-related health outcomes. Conclusion: The identification of a notable relationship between regional health outcomes and population density underscores the utility of incorporating living population metrics as key indicators in the development of policies aimed at mitigating health disparities. Moreover, this finding advocates for strategic expansions of local infrastructure, with a particular emphasis on areas characterized by low living populations.

• RED RIBBON
• /
• s.64
• /
• pp.16-17
• /
• 2005

결핵은 전 세계적으로 가장 흔한 에이즈 관련 기회감염질환의 하나이며, 사하라사막이남 아프리카에서는 에이즈 환자들의 가장 흔한 사망원인이다. 결핵과 HIV는 서로 밀접한 연관성이 있으며, 또한 결핵은 에이즈 환자의 생존에도 많은 영향을 준다. 세계보건기구에 따르면 1997년에 전 세계에서 800만 명의 새로운 결핵환자가 발생하였고, 200만 명이 사망하여 약 $23\%$의 사망률을 보였으며, 이중 결핵과 HIV가 동시에 감염된 경우는 64만 명($8\%$)이었고 이들의 사망률은 $50\%$로 높았다

• Clinical and Experimental Pediatrics
• /
• v.52 no.10
• /
• pp.1175-1180
• /
• 2009

We report a case of a full-term neonate with persistent pulmonary hypertension who developed asphyxia after birth and was treated with iloprost. The neonate had persistent hypoxia and did not respond to supportive treatment. Because inhaled nitric oxide (iNO) was not available in our hospital, inhaled iloprost was administered via an endotracheal tube. This resulted in an immediate elevation of oxygen saturation. Echocardiography revealed the conversion of the right-to-left ductal shunt to the left-to-right one and a decrease of the right ventricular pressure. The use of inhaled iloprost did not cause any significant side effects. Here, we describe our experience where iloprost was used in a neonate with persistent pulmonary hypertension because the standard therapy with inhaled nitric oxide was not available.

• Childhood Kidney Diseases
• /
• v.18 no.1
• /
• pp.47-50
• /
• 2014

Infection is the most important cause of death in children with nephrotic syndrome. Influenza viral infections can be fatal for these children, given the annual outbreak of this virus, with the mortality rate being similar to that of respiratory syncytial virus in healthy children. Pneumonia is recognized as the most important complication of influenza infections, as it is associated with high death rates. However, the influenza vaccine, as well as antiviral agents, can be used for prevention and treatment. Therefore, aggressive management with influenza vaccination and antiviral agents will lower the overall mortality rate in children with nephrotic syndrome. Here we report the case of a 7-year-old boy with nephrotic syndrome and influenza A virus (H1N1) pneumonia.

• Journal of Chest Surgery
• /
• v.32 no.1
• /
• pp.32-37
• /
• 1999

Background: Early detection and surgical resection offer the most advantage out of all cures for lung cancer. Elderly patients may fail to benefit maximally from these interventions because of their general condition and residual lung function. To study the impact of age on stages, histology, symptoms, and treatments of the patients with non-small cell lung cancer, we undertook a retrospective review. Material and Method : Two hundred eleven patients with non-small cell lung cancer were operated on at Samsung Seoul hospital between October 1994 and June 1997. Patients were arbitrarily arbitrarily by age less than 70 years(176 patients) and 70 years or more(35 patients), and their medical records were reviewed. Result: There were no differences in pathologic staging and diagnosis. But there were differences in surgical methods, complications, and mortality rates between the two groups. There were much more complications in the 70 years or more group(p=0.02). We chose less invasive surgical methods in the 70 years or more group. Conclusion: More complications were experienced in the 70 years or more group. Although thoracic operation imparts the greatest survival advantage, this benefit is diminished in elderly patients because of their high complications and mortality rate. We recommend serious consideration of surgical indications and operative methods.

• Journal of Chest Surgery
• /
• v.29 no.11
• /
• pp.1248-1256
• /
• 1996

From June 1987 to December 1994, 372 patients underwent operation for resection of esophageal cancer, and 48 patients with metastasis to distant abdominal lymph nodes were analyzed.. The primary tumors were located predominantly in lower thoracic esophagus(n=29). The location of involved lymph nodes were celiac L/N(n=45), common hepatic L/N(n=4), paraaortic L/N(n=l), and retropancreatic L/N(n=l). Most tumors penetrated the esophageal wall(T3,T4, n=43), metastased to regional L/N(N1, n=41), but a few tumors were limited to the esophageal wall(T1,T2, n=5), metastased to distant abdominal L/N without metastasis to regional L/N(NO, n=7). Resectability rate was 87.5%(42/48), and complete resection was possible in 31 patients(64.6%). The most frequent cause of incomplete resection and unresectability was unresectable T4 lesions(n=8), extranodal invasion(n=7). Overall operative mortality and morbidity was 4.2%, 22.9%, and resection mortality was 4.8%. Adjuvant therapy was given to 27 patients, and postoperative follow-up was possible in all patients(median follow-up, 32 months). The 1 year and 3 year survival for resection group was 54.0%, 18.1%(median, 386 days) including operative deaths. Our results suggest that resection of the esophageal cancer with metastasis to distant abdominal lymph nodes(M1LYN) can be done with acceptable mortality and morbidity, and may playa role in long-term survival in carefully selected patients because prognosis is dismal in unresectable esophageal cancer. We recommend that lymph nodes around celiac axis be dissected thoroughly for exact staging and possible prolongation of survival, and multimodality therapy as necessary because most patients with M1(LYN) esophageal cancer do poorly with only primay surgical treatment.

• Journal of the Korean Society of Radiology
• /
• v.6 no.2
• /
• pp.107-114
• /
• 2012

The study was conducted in patients who had undergone angiography and arterial embolization after being diagnosed with arterial bleeding among those registered with severe trauma at the admission to the department of emergency due to accidents. In the study, comparison was done between the survived group and the nonsurvived group to investigate the usefulness and the optimal performance timing of angiography and embolization as the survival-affecting factors and treatment methods for patients. The study was performed as a retrospective analysis in 45 patients who had undergone angiography and arterial embolization among those categorized as severe trauma patients from the emergency department of H hospital located in Gyeonggi-do from July, 2006 until December, 2010. The Injury Severity Score (ISS), the Revised Trauma Score (RTS), the hematocrit were the main outcome measurements. Arterial embolization was technically successful in all cases, transcatheter arterial embolization of arterial bleeding is a useful procedure in lowering the mortality and complication in severe trauma patients. and RTS, ISS, Hematocrit were the predictable early mortality factors. So bad vital sign patients must be progressed rapidly.

• Journal of Chest Surgery
• /
• v.41 no.2
• /
• pp.253-259
• /
• 2008

Background: The incidence of cervical esophageal cancer is low compared with that of thoracic esophageal cancer, and the role of surgery for cervical esophageal cancer is limited compared with that of radiotherapy or chemotherapy. This study was carried out to determine the outcome of surgery for cervical esophageal cancer. Material and Method: We analyzed retrospectively medical records of 43 patients who had undergone curative surgical resection for cervical esophageal cancer from January 1989 to December 2002. Follow-up loss was absent and the last follow-up was carried out in February 28, 2004. Result: The mean age was 60 years old and the male to female ratio was 40:3. Histologic types were squamous cell carcinoma 42 patients and malignant melanoma 1 patient. The methods used for esophageal reconstruction were gastric pull-up 32 patients, free jejunal graft 7 patients and colon interposition 4 patients. Postoperative complications occurred in 31 patients (72%), and operative mortality occurred in 7 patients (16%). Pathologic stages were I 3, IIa 14, IIb 1, III 19, and IVa 6 patients. Tumor recurrence occurred in 16 patients (44%), and the 3 and 5-year survival rates were 29.3% and 20.9%. Conclusion: The reported surgical results for cervical esophageal cancer showed somewhat high operative mortality, postoperative complication rates and recurrence rates and a low long-term survival rate. It is suggested that multimodality treatment including surgery is needed for the treatment of cervical esophageal cancer because radiotherapy or chemotherapy without surgery could not relieve dysphagia or resolve the tumor completely.

• Journal of the Korean Society of Radiology
• /
• v.84 no.4
• /
• pp.784-791
• /
• 2023

Based on statistics available in Korea, trauma centers play a critical role in treatment of patients with trauma. Interventional radiologists in trauma centers perform various procedures, including embolization, which constitutes the basic treatment for control of hemorrhage, although interventions such as stent graft insertion may also be used. Although emergency interventional procedures have been used conventionally, rapid and effective hemorrhage control is important in patients with trauma. Therefore, it is important to accurately understand and implement the concept of damage control interventional radiology, which has gained attention in recent times, to reduce preventable trauma-induced mortality rates.