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Comparison of Outcomes after Curative Resection of Primary Lung Cancer between 50 Year or Younger and 70 Year or Older Patients (50세 이하와 70세 이상 원발성 폐암 환자에서의 근치적 수술 후 성적 비교)

  • Lee, Jae-Ik;Kim, Keun-Woo;Park, Kook-Yang;Park, Chul-Hyun;Jeon, Yang-Bin;Choi, Chang-Hyu
    • Journal of Chest Surgery
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    • v.42 no.2
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    • pp.206-213
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    • 2009
  • Background: Previous series have suggested that younger patients with primary lung cancer exhibit a more aggressive disease course with a worse prognosis, as compared to older patients, although this issue is still debatable. Material and Method: We reviewed the medical records of 79 patients (32 patients 50 years and younger (Group I) and 47 patients 70 years and older (Group II)) who underwent curative resection for primary lung cancer between July 2000 and June 2008. Result: The median age of the patients was 46.5 years in Group I and this was 73 years in Group II. The older patients were more likely to have major comorbidities (44% versus 77%, respectively; p=0.003). Histological examinations identified that the minor histological types (excluding non-small cell lung cancer (NSCLC)) were predominantly found in the Group I patients (16% versus 2%, respectively; p=0.037). For the TNM staging of the NSCLC, with excluding the minor histologic types, a higher proportion of patients had stage III disease in Group I (33% versus 13%, respectively; p=0.038). There was no significant difference in major morbidity (16% versus 30%, respectively; p=0.148) and operative mortality (0% versus 4.3%; p=0.512) between the groups. The mean follow-up interval was 33 months (range: $1{\sim}98$ months) for patients in both groups. For the patients with NSCLC, the five-year overall survival rate was 52.3% for Group I and 53.7% for Group II (p=0.955). The rate of freedom from recurrence at five years was significantly lower for the Group I patients than for the Group II patients (39.4% versus 70.4%, respectively; p=0.027), and only being a member of Group I impacted recurrence, based on the Cox proportional hazard analysis (p=0.034). Of the patients who had recurrence, four patients in Group I underwent aggressive surgical treatment. All of these patients exhibited long-term survival (range: $46{\sim}87$ months). Conclusion: In our study, the early outcome and long-term survival were similar for the younger and older patients after curative resection of primary lung cancer. However, we think that younger patients require meticulous follow-up as they had a tendency to proceed to surgery with advanced stage disease, a higher recurrence rate than did the older patients and the survival rates were improved, even for the recurred cases, with early aggressive treatment.

The influence of wearing helmet and cervical spine injury in skiers and snowboarders (스키와 스노우 보드에서 헬멧의 착용이 경추부 손상에 미치는 영향)

  • Kim, Sung Hun;Kim, Tae Kyun;Chun, Keun Churl;Hwang, Jae Sun
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.10 no.2
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    • pp.94-99
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    • 2011
  • Purpose: As the number of people enjoying skiing and snowboarding which are two popular winter sports has been increasing, wearing helmet during doing these sports has been needed for safety. The rates of head or face injury have decreased after using helmet. However the effect that wearing helmet has on cervical damage is not yet to be known. So through this research we intend to be helpful in developing effective program and safety equipment. Materials and Methods: During two seasons from December 2009 to march 2011, cased 658 cervical injuries within 14538 admittance in medical center of major resort due to skiing and snow-boarding injuries. For survey and research model, one year before the research year conducted a pilot study. Admittance were 432 male and 226 female, advanced 273 and 385 novice. We divided them into two groups depending on wearing helmet, measured cervical damage ratio and injury mechanism, and researched the severity of damage and diagnosed injury. Each group used SPSS 12.0 (SPSS Inc., Chicago, IL, USA) to process data statistically. Results: The number of patients was 312 in skier and 346 in snow boarder. Patients wearing helmet were 146 in skier and 127 in snow boarder. Classification of each injuries were confirmed as 292 cases of simple sprain, 359 bruising, 6 cervical fractures and 1 case of dislocation. Classification of injury mechanisms were 287 of human collision, 212 material collision, 108 of slip down by oneself, 39 of falling and 12 cases of etc. In cases wearing helmet ski 78/ snow board 70 were simple sprain, ski 64/ snowboard 68 were shown as bruising, ski 1/ snow board 2 had cervical fracture or dislocation. The ratio of cervical sprain increased in cases of wearing helmet compared to non-wearing cases and there was a statistical significance (p<0.001). The ratio of cervical contusion increased significantly in non-wearing helmet user (p<0.05). However, there was no significant increase in fracture and dislocation compared between helmet user and non-user (p> 0.05). Conclusion: In this study, wearing helmet had no relation to additional cervical injury occurrence or severity among skiers and snow boarders. The ratio of cervical sprain increased significantly in helmet user with person to person accident. However, the cervical contusion decreased. On this ground, further biomechanical studies are required and modified helmet will be necessary.

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Spatial Distribution of Pigment Concentration Around the East Korean Warm Current Region Derived from Satellite Data - Satellite Observation in May 1980 - (위성원격탐사에 의한 동한난류 주변 해역의 색소농도 공간적 분포 -1980년 5월 관측을 중심으로 -)

  • Kim Sang Woo;Saitoh Sei-ich;Kim Dong Sun
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.35 no.3
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    • pp.265-272
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    • 2002
  • Spatial distribution of Phytoplankton Pigment Concentration (PPC) and Sea Surface Temperature (SST) around the East Korean Warm Current (EKWC) was described, using both Coastal Zone Color Scanner (CZCS) images and Advanced Very High Resolution Radiometer (AVHRR) images in May, 1980. Water mass in this region can be classified into five categories in the horizontal profile of PPC and SST, nLw (normalized water-leaving radiance) images: (1) coastal cold water region associated with concentrations of dissolved organic material or yellow colored substances and suspended sediments, (2) cold water region of thermal frontal occurred by a combination of phytoplankton absorption and suspended materials, (3) warm water overlay region by the phytoplankton absorption than the suspended materials; (4) warm water region occurred by the low phytoplankton absorption, and (5) offshore region occurred by the high phytoplankton absorption. In particular, the highest PPC (>2.0 mg/m^3) area appeared in the CZCS and AVHRR images with a band shaped distribution of the thermal front and ocean color front region, which is located the coastal cold waters alonB western thermal front of the warm streamer of the EKWC. In this region, the highest PPC occurred by a combination of the high absorption of the phytoplankton (443 nm) and highest reflectance of suspended materials (550 nm). Another high PPC ($\simeq$$6\;mg/m^3$) appeared in the warm water overlay region inside warm streamer. High phytoplankton pigment concentration of this region was corresponding to the short wavelength of 443 nm, which represented phytoplankton absorption of the CZCS image.

Clinical Analysis for the Result after Curative Resection of Esophageal Cancer (식도암에서 근치적 절제술 후의 성적에 대한 임상적 고찰)

  • 이재익;노미숙;최필조
    • Journal of Chest Surgery
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    • v.37 no.4
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    • pp.356-363
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    • 2004
  • Esophageal cancer is an aggressive disease with a poor prognosis. Recently, every effort has been made to improve the long term survival, but the general prognosis for patients with this disease remains poor. In this study, we reviewed 8 years of experiences with esophageal cancer patients managed in our department at Dong-A University Hospital and evaluated the effectiveness of cervical lymph node dissection performed selectively. Material and Method: From January 1995 to August 2003, 70 patients underwent esophagectomy for esophageal cancer in our department. Among them, 51 patients who underwent curative resection, had no double primary tumors and no neoadjuvant therapy were analyzed retrospectively. In most patients, intrathoracic esophagectomy and cervical esophago-gastrostomy was performed. Since 1997, 3-field lymph node dissection was performed selectively. Result: There were 46 men and 15 women. The median age was 60 years. The tumor was located in the upper third part in 10 patients (19%), middle third in 21 (41%), and lower third in 20 (40%). Majority of the patients (90%) had squamous cell carcinoma. Cervical anastomosis was made in 41 patients, and intrathoracic anastomosis in 10. 2-field lymph node dissection was done in 40 patients, and 3-field lymph node dissection in 11. The pathologic staging were as follows: stage I in 9 patients (17.6%), IIA in 20 (39.2%), IIIB in 7 (13.7%), III in 11 (21.6%), IVA in 2 (3.9%), and IVB in 2 (3.9%). The in-hospital mortality was 3.9% (2 patients) and complications occurred in 24 patients (47%). Overall actuarial 1, 3, and 5-year survival rates were 74.4%, 48.4%, and 48.4% including operative mortality. The 4-year survival rate did not differ significantly between 3-field lymph node dissection group (50.5%) and 2-field lymph node dissection group (48.9%). In 3-field lymph node dissection group, the respiratory complications were more frequent and operative time was significantly longer. Conclusion: We think that curative resection for esophageal cancer can be performed with acceptable mortality, and aggressive surgical approach may improve the long term survival. even for advanced stages. Effectiveness of 3-field lymph node dissection needs further investigations.

Analysis of Exploratory Thoracotomy in Non-Small Cell Lung Cancer (원발성 폐암에서의 시험적 개흉술의 분석)

  • 허재학;성숙환;김영태
    • Journal of Chest Surgery
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    • v.32 no.6
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    • pp.536-542
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    • 1999
  • Background: The purpose of this study is to improve the quality of the diagnostic procedures in the preoperative evaluation so as to reduce the unnecessary thoracotomy and to ensure resectability in non-small cell lung cancer. Material and Method: Of 616 patients who underwent thoracotomy for primary lung cancer from January 1990 to December 1996, 59 patients(9.6%) turned out to have inoperable lesions after the thoracotomy. We reprospectively reviewed the bronchoscopic findings, methods of tissue diagnosis, CT scans, pulmonary function test and lung perfusion scan, reasons for nonresectability, and adjuvant therapy, and then followed up on the survival rate after exploratory thoracotomy. Result: The cell types were squamous cell carcinoma in 38, adenocarcinoma in 15, large cell carcinoma in 3 and others in 3. Primary loci were RUL in 20, RML in 6, RLL in 8, LUL in 13, LLL in 4 and others in 8. The reasons for non-resectability were various; direct tumor invaison to mediastinal structures(n=41), seeding on pleural cavity(n=8), poor pulmonary function(n=2), invasions to extranodal mediastinal lymph node(n=2), technical non- resectability due to extensive chest wall invasion (n=3), small cell carcinoma (n=1), malignant lymphoma(n=1), and multiple rib metastases(n=1). In the follow-up of 58 patients, 1-year survival rate was 55.2% and 2-year survival rate was 17.2% and the mean survival time was 14 months. When compared according to cell types or postoperative adjuvant therapeutic modalities, no significant difference in the survival rates were found. The squamous cell carcinoma was frequently accompanied by local extension to contiguous structures and was the main cause of non-resectability. In adenocarcinoma, pleural seeding with malignant effusion was frequently encountered, and was the major reason for non-resectability. Conclusion: These data revealed that if appropriate preoperative diagnostic tools had been available, many unnecessary thoracotomies could have been avoided. Both the use of thoracoscopy in selected cases of adenocarcinoma and the more aggressive surgical approach to the locally advanced tumor could reduce the incidence of unnecessary thoracotomies for non-small cell lung cancers.

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Transcatheter Arterial Embolization for Hemoptysis (객혈환자에서 동맥 색전술의 효과)

  • Yoo, Byung-Su;Ryu, Jeong-Seon;Lee, Won-Yeon;Song, Kwang-Seon;Ahn, Kang-Hyun;Yong, Suk-Joong;Shin, Kye-Chul;Kim, Young-Ju
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.1
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    • pp.50-57
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    • 1995
  • Background: Transcather arterial embolization has been established as an effective means to control hemoptysis, especially in patients with decreased pulmonary function such as postpneumonectomy patients and those with advanced chronic obstructive pulmonary disease. We evaluated the effect of arterial embolization and analysed the correlation of the clinical and angiographic characteristics and investigated the clinical course and outcome after arterial embolization in the patients with significant hemoptysis. Method: 58 patients with massive or recurrent hemoptysis underwent transcatheter arterial embolization for the treatment of hemoptysis from April 1992 to Sept. 1993. Results: Most common cause of hemoptysis was pulmonary tuberculosis(34 cases, 58.3%). Embolized vessels responsible for hemoptysis were 56 bronchial arteries and 32 nonbronchial systemic arteries. Initial most common angiographic findings were hypervascularity and shunt. Initial success rate of hemoptysis control revealed 81.1%. However, 15 of 58 patients(25.9%) showed recurrence of hemoptysis after transcatheter arterial embolization. The complications(18 cases, 31%) such as chest pain, fever, voiding difficulty, atelectasis, paralytic ileus and unwanted embolization were occured. Conclusion: Transcatheter arterial embolization is useful and relatively safe treatment modality for immediate bleeding control of patients with massive hemoptysis or inoperable cases. The further evaluation of the long term results according to the embolized material and underlying pulmonary disease will be required.

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A Study on the Diffusion Factor of e-finance (e-Finance의 확산요인에 관한 연구)

  • Kim, Min-Ho;Song, Chae-Hun;Song, Sun-Yok;Cha, Sun-Kwon
    • International Commerce and Information Review
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    • v.4 no.2
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    • pp.253-277
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    • 2002
  • Nowaday, the advanced technology in information and communication has been leading the dramatic change of transaction paradigm expansion from physical basis to electronic one. As we know, financial services support most of financial exchange between two business parties. So the expansion of electronic transaction paradigm affects to every financial institutions which provide financial services. Thus, financial institutions have accepted e-Finance systems and providing internet financial services to live in the competition. The purpose of this study is to contribute the qualitative enhancement of its customer service, rapid diffusion and accurate strategy establishment for e-Finance industry in the user side. Through the literature review and factor and reliability analysis, this study selects six diffusion factors such as efficiency of perceived e-Finance, reliability and safety of e-Finance in perceived e-Finance itself's characteristic; confidence, technical factors and the customer service quality of e-Finance system in perception on e-Finance System; inclination to innovation in the personal characteristic. According to result of hypothesis verification by using logistics regression analysis, technical factors and the customer service quality of e-Finance system in perception on e-Finance System and inclination to innovation in the personal characteristic gave statistically positive effect to the diffusion decision at the significant level 0.05 and 0.01. However efficiency of perceived e-Finance, reliability and safety of e-Finance in perceived e-Finance itself's characteristic didn't affect to diffusion decision and confidence of e-Finance system in perception on e-Finance System didn't have any statistical significancy. This study can be used as a basic material for the forward empirical study of diffusion factors in the user side and be able to apply to company and government policy making or embodiment, determination for customer service quality degree of financial institutions. But this study has some limitations like didn't touch satisfaction factors and its effect, only deal domestic customers and didn't use multi-regression analysis.

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Methylation of P16 and hMLH1 in Gastric Carcinoma (위암에서 P16 및 hMLH1 유전자의 메틸화)

  • Sung, Gi-Young;Chun, Kyung-Hwa;Song, Gyo-Yeong;Kim, Jin-Jo;Chin, Hyung-Min;Kim, Wook;Park, Cho-Hyun;Park, Seung-Man;Lim, Keun-Woo;Park, Woo-Bae;Kim, Seung-Nam;Jeon, Hae-Myung
    • Journal of Gastric Cancer
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    • v.5 no.4 s.20
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    • pp.228-237
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    • 2005
  • Purpose: We investigated the impacts of the methylation states of the P16 and the hMLH1 genes on pathogenesis and genetic expression of stomach cancer and their relationships with Helicobater pylori infection, and with other clinico-pathologic factors. Material and Methods: In our study, to detect protein expression and methylation status of the P16 and the hMLH1 genes in 100 advanced gastric adenocarcinomas, used immunohistochemical staining and methylation-specific PCR (MSP) and direct automatic genetic sequencing analysis. Results: Methylation of the P16 gene was observed in 19 out of 100 cases (19%) and in the 18 of those cases (94.7%) loss of protein expression was seen. We were sble to show that loss of P16 gene expression was related to methylation of the P16 gene (kappa coefficient=0.317, p=0.0011). Methylation of the hMLH1 gene was observed in 27 cases (27%), and in 24 cases of those 27 cases (88.8%), loss of protein expression was seen, which suggested that loss of protein expression in the hMLH1 gene is related to methylation of hMLH1 gene (kappa coefficient=0.675, P<0.0001). Also methylation of the hMLH1 gene was related to age, size of the mass, and lauren's classification. Conclusion: We found that methylation of DNA plays an important role in inactivation of the P16 and the hMLH1 genes. The methylation of the hMLH1 genes is significantly related to age, size of the mass, and lauren's classification.

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Structural Relationships Among Factors to Adoption of Telehealth Service (원격의료서비스 수용요인의 구조적 관계 실증연구)

  • Kim, Sung-Soo;Ryu, See-Won
    • Asia pacific journal of information systems
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    • v.21 no.3
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    • pp.71-96
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    • 2011
  • Within the traditional medical delivery system, patients residing in medically vulnerable areas, those with body movement difficulties, and nursing facility residents have had limited access to good healthcare services. However, Information and Communication Technology (ICT) provides us with a convenient and useful means of overcoming distance and time constraints. ICT is integrated with biomedical science and technology in a way that offers a new high-quality medical service. As a result, rapid technological advancement is expected to play a pivotal role bringing about innovation in a wide range of medical service areas, such as medical management, testing, diagnosis, and treatment; offering new and improved healthcare services; and effecting dramatic changes in current medical services. The increase in aging population and chronic diseases has caused an increase in medical expenses. In response to the increasing demand for efficient healthcare services, a telehealth service based on ICT is being emphasized on a global level. Telehealth services have been implemented especially in pilot projects and system development and technological research. With the service about to be implemented in earnest, it is necessary to study its overall acceptance by consumers, which is expected to contribute to the development and activation of a variety of services. In this sense, the study aims at positively examining the structural relationship among the acceptance factors for telehealth services based on the Technology Acceptance Model (TAM). Data were collected by showing audiovisual material on telehealth services to online panels and requesting them to respond to a structured questionnaire sheet, which is known as the information acceleration method. Among the 1,165 adult respondents, 608 valid samples were finally chosen, while the remaining were excluded because of incomplete answers or allotted time overrun. In order to test the reliability and validity of the assessment scale items, we carried out reliability and factor analyses, and in order to explore the causal relation among potential variables, we conducted a structural equation modeling analysis using AMOS 7.0 and SPSS 17.0. The research outcomes are as follows. First, service quality, innovativeness of medical technology, and social influence were shown to affect perceived ease of use and perceived usefulness of the telehealth service, which was statistically significant, and the two factors had a positive impact on willingness to accept the telehealth service. In addition, social influence had a direct, significant effect on intention to use, which is paralleled by the TAM used in previous research on technology acceptance. This shows that the research model proposed in the study effectively explains the acceptance of the telehealth service. Second, the research model reveals that information privacy concerns had a insignificant impact on perceived ease of use of the telehealth service. From this, it can be gathered that the concerns over information protection and security are reduced further due to advancements in information technology compared to the initial period in the information technology industry, and thus the improvement in quality of medical services appeared to ensure that information privacy concerns did not act as a prohibiting factor in the acceptance of the telehealth service. Thus, if other factors have an enormous impact on ease of use and usefulness, concerns over these results in the initial period of technology acceptance may become irrelevant. However, it is clear that users' information privacy concerns, as other studies have revealed, is a major factor affecting technology acceptance. Thus, caution must be exercised while interpreting the result, and further study is required on the issue. Numerous information technologies with outstanding performance and innovativeness often attract few consumers. A revised bill for those urgently in need of telehealth services is about to be approved in the national assembly. As telemedicine is implemented between doctors and patients, a wide range of systems that will improve the quality of healthcare services will be designed. In this sense, the study on the consumer acceptance of telehealth services is meaningful and offers strong academic evidence. Based on the implications, it can be expected to contribute to the activation of telehealth services. Further study is needed to assess the acceptance factors for telehealth services, such as motivation to remain healthy, health care involvement, knowledge on health, and control of health-related behavior, in order to develop unique services according to the categorization of customers based on health factors. In addition, further study may focus on various theoretical cognitive behavior models other than the TAM, such as the health belief model.

Evaluation on Spectral Analysis in ALOS-2 PALSAR-2 Stripmap-ScanSAR Interferometry (ALOS-2 Stripmap-ScanSAR 위상간섭기법에서의 스펙트럼 분석 평가)

  • Park, Seo-Woo;Jung, Seong-Woo;Hong, Sang-Hoon
    • Korean Journal of Remote Sensing
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    • v.36 no.2_2
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    • pp.351-363
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    • 2020
  • It is well known that alluvial sediment located in coastal region has been easily affected by geohazard like ground subsidence, marine or meteorological disasters which threaten invaluable lives and properties. The subsidence is a sinking of the ground due to underground material movement that mostly related to soil compaction by water extraction. Thus, continuous monitoring is essential to protect possible damage from the ground subsidence in the coastal region. Radar interferometric application has been widely used to estimate surface displacement from phase information of synthetic aperture radar (SAR). Thanks to advanced SAR technique like the Small BAseline Subset (SBAS), a time-series of surface displacement could be successfully calculated with a large amount of SAR observations (>20). Because the ALOS-2 PALSAR-2 L-band observations maintain higher coherence compared with other shorter wavelength like X- or C-band, it has been regarded as one of the best resources for Earth science. However, the number of ALOS-2 PALSAR-2 observations might be not enough for the SBAS application due to its global monitoring observation scenario. Unfortunately, the number of the ALOS-2 PALSAR-2 Stripmap images in area of our interest, Busan which located in the Southeastern Korea, is only 11 which is insufficient to apply the SBAS time-series analysis. Although it is common that the radar interferometry utilizes multiple SAR images collected from same acquisition mode, it has been reported that the ALOS-2 PALSAR-2 Stripmap-ScanSAR interferometric application could be possible under specific acquisition mode. In case that we can apply the Stripmap-ScanSAR interferometry with the other 18 ScanSAR observations over Busan, an enhanced time-series surface displacement with better temporal resolution could be estimated. In this study, we evaluated feasibility of the ALOS-2 PALSAR-2 Stripmap-ScanSAR interferometric application using Gamma software considering differences of chirp bandwidth and pulse repetition frequency (PRF) between two acquisition modes. In addition, we analyzed the interferograms with respect to spectral shift of radar carrier frequency and common band filtering. Even though it shows similar level of coherence regardless of spectral shift in the radar carrier frequency, we found periodic spectral noises in azimuth direction and significant degradation of coherence in azimuth direction after common band filtering. Therefore, the characteristics of spectral bandwidth in the range and azimuth direction should be considered cautiously for the ALOS-2 PALSAR-2 Stripmap-ScanSAR interferometry.