No abstract available.
Fascia* ; Nasolabial Fold*

OBJECTIVE: To quantify the economic value of the Sirolimus Eluting Stent (CYPHER(TM)) in treating acute coronary heart disease (CHD), and to assist in determining an adequate level of reimbursement for CYPHER(TM) in Korea. METHODS: A decision-analytical model, developed by the Belgium Health Economics Disease Management group, was used to investigate the incremental cost-effectiveness of CYPHER(TM) versus conventional stenting. The time horizon was five years. The probabilities for clinical events at each node of the decision model were obtained from the results of large, randomized, controlled clinical trials. The initial care and follow-up direct medical costs were analyzed. The initial costs consisted of those for the initial procedure and hospitalization. The follow-up costs included those for routine follow-up treatments, adverse reactions, revascularization and death. Depending on the perspective of the analysis, the costs were defined as insurance covered or total medical costs (=sum of insurance covered and uncovered medical costs). The cost data were obtained from the administrative data of 449 patients that received conventional stenting from five participating Korean hospitals during June 2002. Sensitivity analyses were performed for discount rates of 3, 5 and 7%. Since the major clinical advantage of CYPHER(TM) over conventional stenting was the reduction in the revascularization rates, the economic value of CYPHER(TM), in relation to the direct medical costs of revascularization, were evaluated. If the incremental cost of CYPHER(TM) per revascularization avoided, compared to conventional stenting, was no higher than that of a revascularization itself, CYPHER(TM) would be considered as being cost-effective. Therefore, the maximum acceptable level for the reimbursement price of CYPHER(TM) making the incremental cost-effectiveness ratio equal to the cost of a revascularization was identified. RESULTS: The average weighted initial insurance covered and total medical costs of conventional stenting were about 6, 275, 000 and 8, 058, 000 Won, respectively. The average weighted sum of the initial and 5-year follow-up insurance covered and total medical costs of conventional stenting were about 13, 659, 000 and 17, 353, 000 Won, respectively. The estimated maximum level of reimbursement price of CYPHER(TM) from the perspectives of the insurer and society were 4, 126, 897 ~ 4, 325, 161 and 4, 939, 939 ~ 5, 078, 781 Won, respectively. CONCLUSION: By evaluating the economic value of CYPHER(TM), as an alternative to conventional stenting, the results of this study are expected to provide a scientific basis for determining the acceptable level of reimbursement for CYPHER(TM).
Belgium ; Coronary Disease* ; Cost-Benefit Analysis ; Decision Support Techniques ; Disease Management ; Follow-Up Studies ; Hospitalization ; Humans ; Insurance ; Insurance Carriers ; Korea ; Sirolimus* ; Stents*

No abstract available.
Heart Septal Defects, Atrial* ; Hemodynamics*

BACKGROUND/AIMS: As a tumor marker, alpha-etoprotein is widely used. Diagnositic cut-ff value is known as 400 ng/mL in sera. This study is aimed to determine the clinical features of hepatocellular carcinoma (HCC) with reference to serum AFP levels in Korean patients. METHODS: From May 1990 to March 1998, 367 patients diagnosed as HCC, hospitalized and followed-p at Hanyang University Hospital, have been retrospectively analyzed with special reference on serum AFP level at time of diagnosis. The differences in clinical, hematological, and radiological features of HCC, as well as the survival rate in the two groups have been compared. Group 1 (N=182) was defined as an AFP level lower than 400 ng/mL, group 2 (N=185) was defined as an AFP level greater than 400 ng/mL. Comparisons were made by student's t test or chi-quare test. Survival rate was calculated from the time of diagnosis by Kaplan-eier method. Survival curves were also compared using log-ank test. P values less than 0.05 were considered significant. RESULTS: The patients with serum AFP levels above 400 ng/mL showed (1) a lower mean age; (2) a higher level of AST; (3) a higher level of AST/ALT ratio; (4) a high incidence of liver cirrhosis; (5) a high incidence of portal vein thrombosis; (6) a high incidence of positive HBsAg; (7) a low incidence of anti-CV; (8) a low incidence of small HCC but high incidence of large HCC; (9) a high incidence of more advanced TNM stage; (10) a low incidence of single nodular type and high incidence of diffuse type. CONCLUSIONS: Depending on the value of AFP, HCC has some clinical features. In hepatocellular carcinoma, high levels of AFP represent young age, HBV infection more than HCV infection and advanced disease state.
Carcinoma, Hepatocellular* ; Diagnosis ; Hepatitis B Surface Antigens ; Humans ; Incidence ; Liver Cirrhosis ; Retrospective Studies ; Survival Rate ; Venous Thrombosis

Korean National Health Insurance (NHI) was established during only 12 yr from its inception (1977-1989), providing universal medical coverage to the entire nation and making a huge contribution to medical security. However, the program now faces many challenges in terms of sustainability. The low birth rates, aging population, low economic growth, and escalating demands for welfare, as well as unification issues, all add pressure to the sustainability of NHI. The old paradigm of low contribution - low benefits coverage - low NHI's fee schedule needs to be replaced by a new paradigm of proper contribution - adequate benefit coverage - fair NHI's fee schedule. This new paradigm will require reform of NHI's operating system, funding, and spending.
Health Care Reform ; Humans ; National Health Programs/*economics ; Program Evaluation ; Republic of Korea ; Risk Factors ; Universal Coverage/economics

PURPOSE: Many studies from the past have indicated that women tend to have lower self- esteem than men. This cross-sectional study looks for this tendency in a medical school in Korea, where men are still thought to comprise much of a dominating force despite the current growth in number of female students in student body. Along with the cross-examination of possible gender difference in self-esteem, the significant and relevant factors will also be sought and discussed. METHODS: Questionnaires were obtained from 202 junior and senior students (125 male and 77 female students) in a medical school in Korea. Self-esteem was determined using the Rosenberg self-esteem scale (reliability = 86% in our study). Multiple regression analysis was used to determine gender difference in self-esteem and statistical relevance in each covariate. RESULTS: There was no statistically significant difference in self-esteem between male and female medical students. Significant factors related to self-esteem include school rank, physical attractiveness, and depression, among which of them, depression was the strongest. CONCLUSION: Innate limitation of cross-sectional studies and evaluation of selected junior and senior students of a single medical school could possibly explain for the absence of gender difference in self-esteem in this study. Academic achievement and physical attractiveness are shown to be positive factors for self-esteem, while depression puts negative force in one's self-esteem.
Cross-Sectional Studies ; Depression ; Female ; Humans ; Korea ; Male ; Schools, Medical ; Students, Medical* ; Surveys and Questionnaires

Multiple pulmonary nodules were found in a 71-year-old Korean female patient with cutaneous squamous cell carcinoma during diagnostic work-up. A presumptive diagnosis of metastases was made and percutaneous fine needle aspiration cytology was undertaken. Finally, pathological examination of the tissue revealed granulomatous inflammation with cryptococcal infection. The patient received 6 months of antifungal treatment with fluconazole and her chest radiographic findings were improved after the treatment. She is now under clinical follow-up. Recognition that pulmonary cryptococcal infection can mimic metastasis is important in reaching the correct diagnosis and in determining the correct treatment.
Aged ; Biopsy, Fine-Needle ; Carcinoma, Squamous Cell* ; Cryptococcosis* ; Cryptococcus ; Diagnosis ; Female ; Fluconazole ; Follow-Up Studies ; Humans ; Inflammation ; Multiple Pulmonary Nodules ; Neoplasm Metastasis* ; Radiography, Thoracic

PURPOSE: Korea started breast cancer screening as part of the National Cancer Screening Program (NCSP) in 1999. In order to identify under-served groups, we investigated mammography uptake in the National Breast Cancer Screening Program. MATERIALS AND METHODS: The study population was participants in the National Breast Cancer Screening Program from 2004 to 2008. We analyzed participation rates by insurance type, age group, and area of residence. RESULTS: Total participation rates for breast cancer screening increased from 18.2% in 2004 to 35.0% in 2008. The participation rate in the group aged 60 to 69 years showed the greatest increase, 21.3%, among the four age groups. Although the screening rate increased continuously, the participation rate of the Medical Aid Program (MAP) group was low compared to the National Health Insurance (NHI) group. Moreover, the increasing trend of mammography uptake in the MAP group was much lower than that of the NHI group. CONCLUSION: The participation rate for breast cancer screening in the NCSP in Korea has increased. However, the participation rate in mammography among MAP recipients is still lower than that of NHI beneficiaries. To increase mammography uptake, it is important to make it available to everyone by ensuring inclusion of all population subgroups.
Aged ; Breast ; Breast Neoplasms ; Early Detection of Cancer ; Humans ; Insurance ; Korea ; Mammography ; Mass Screening ; National Health Programs ; Patient Participation

BACKGROUNR/AIMS: Heterogeneity of liver cell populations within the hepatic lobules can affect xenobiotic reaction. In this study, we attempt to clarify the stereological distribution of the y-GTP positive foci in hepatic lobule initiated by diethylnitrosamine and promoted by phenobarbital. METHODS/METERIALS: To the five Sprague-Dawley rats, one day after birth, diethylnitrosamine (0.15 pmole/pn) was intraperitoneally injected and by the weaning at four weeks of life, 0.035% phenobarbital in drinking water was fed for four weeks, at which time the rats were sacrified to obtain the livers. Livers were fixed in fresh cold ethanol acetic acid. Ihe 200 cotmecutive tissue sections were stained by histochemistry for y-GIP and countastained with toluidine blue ar HkE. Employing Zeiss microprojector, y-GTP foci wae traced. And then the largest cross-sectian (size class: 65-165 pm in diameter) of 52 y-GTP foci were selected. Using microscopic grid, distances fiom center of y-GlP foci to nearest centtal vein and bile ductule was measured. As a control group, out of 52 random points determined by rareken digit table, the distances were measured by the same romr. RESULT: the diameter Aom the central points of y-GIP positive foci to the neatest bile ductules was measured as 0.234620+0.14899mm (mean+SD) and the diameter from random points to the neatest bile ductules was measured as 0.303080+0.19582mm (mean+SD). Y-GTP positive foci located within 0.3mm diameter fram bile ductules were counted as 73.1% of 52 foci, whereas that of random points were only 55.8%. Accoring to Aequency table analysis by Shapiro-Wilk W test, there was significant difference by W-value (0.812065) and p-value (0.0144866). CONCLUSION: Stereologically, y -GTP positive foci initiated by diethylnitros;unine, promoted by phaxkarbital in neonatal Spague-Dawley rats were non-rarxlanly distributed in peripcetal atea (Rappaport zone I) in hepatic lobule during hepatocarcinogenesis.
Acetic Acid ; Animals ; Bile ; Diethylnitrosamine ; Drinking Water ; Ethanol ; Liver* ; Parturition ; Phenobarbital ; Population Characteristics ; Rats* ; Rats, Sprague-Dawley* ; Tolonium Chloride ; Veins ; Weaning

BACKGROUND/AIMS: Hepatocytes on the hepatic lobule mipate from portal zone to centrilobular mea as the DNA synthesis within it. And also, the xenobiotic reactions reveal characteristic differences associated with zone specific metabolism in the liver acinus. In this study, the zonal distribution of ethylnitrosourea (ENU)-induced hepatic precancerous lesion was stereologically investigated. METHODS: Nine B6C3F1 mices were given I.p. injection of ENU (60 ug/pn body weight) when the pups were 15 days old prior to sacrifices at 8 weeks of life. All the 150 consecutive sections, 3 p m in thickness, were stained with hematoxylin and eosin and identified the basophilic precancerous lesions with 80-165 p m diameter in equatorial plane by the Zeiss microprojector. And then the distances from the center of selected foci to terminal hepatic vein or portal vein branches were estimated under the microscopic fields. As a control group, the same estimations were performed from the random points by the appointments of random digit table. RESULTS: Mean distance between ENU-induced 52 hepatocellular foci and the nearest terminal hepytic vein was 181.15+112.39 p m (Mean+ SD), but that of randomly selected 104 points was 291.73+157.98pm (Mean+5D) (Students t-test, p<0.0005). Substantially, 52.7% of ENU-induced 52 hepatocellular foci were within 300 p m from the terminal hepatic vein, but randomly selected 104 points were only 50.9% (Shapiro Wilk W test, w=0.819857, p=0.048038). Mean distance from ENU-induced 52 foci to portal vein was 398.85+149.98pm (Mean+SD), but that from the randomly selected 104 points was 315.87+145.79 pm (Mean+SD)(Students t-test, p<0.0005). CONCLUSION: Stereologically, ENU-induced mice liver cell foci distribute non-randomly to Zone III, centrilobular zone of mouse hepatic acini where promote invasion toward terminal hepatic veins.
Animals ; Appointments and Schedules ; Basophils ; Cholestasis ; DNA ; Eosine Yellowish-(YS) ; Ethylnitrosourea ; Fluconazole ; Hematoxylin ; Hepatic Veins ; Hepatocytes ; Liver ; Metabolism ; Mice* ; Portal Vein ; Veins