No abstract available.
Cytomegalovirus Infections* ; Cytomegalovirus*

It is very important to estimate the future medical care expenditure, because medical care expenditure escalation is a big problem not only in the health industry but also in the Korean economy today. This study was designed to project the medical care expenditure in view of population age change. The data of this study were the population projection data based on National Census Data (1990) of the National Statistical Office and the Statistical Reports of the Korea Medical Insurance Corporation. The future medical care expenditure was eatimated by the regression model and the optional simulation model. The significant results are as follows; 1. The future medical care expenditure will be 3,963 billion Won in the year 2000, 4,483 billion Won in 2010, and 4,826 billion Won in 2020, based on the 1990 market price considering only the population age change. 2. The proportion of the total medical care expenditure in the elderly over 65 will be 10. 4% in 2000, 13.5% in 2010, and 16.9% in 2020. 3. The future medical care expenditure will be 4,306 billion Won in the year 2000, 5,1101 billion Won in 2010, and 5, 699 billion Won in 2020 based on the 1990 market price considering the age structure change and the change of the case-cost estimated by the regression model. 4. When we consider the age-structure change and inflation compared with the preceding year, the future medical care expenditurein 2020 will be 21 trillion Won based on a 5% inflation rate, 42 trillion Won based on a 7.5% inflation rate, and 84 trillion Won based on a 10% inflation rate. Consideration of the aged (65 years old and over)will be essential to understand the acute increase of medical care expenditure due to changes in age structure of the population. Therefore, alternative policies and programs for the caring of the aged should be further studied.
Aged ; Censuses ; Population Forecast ; Health Expenditures* ; Humans ; Inflation, Economic ; Insurance ; Korea

To determine the effect of percutaneous transluminal coronary angioplasty on the left ventricular diastolic filling in patients with coronary artery disease, diastolic filling was serially examined before, early(within 2 days) and late(5~15 days) after PTCA using pulsed Doppler echocardiography in 14 patients(12 unstable angina; 2 stable angina). The Control group was consisted of 20 normal persons with similar age and sex distribution. The left anterior descending artery was dilated in 10 patients, the right coronary artery in 3 patients, and the circumflex artery in 1 patient. Peak velocity of early diastolic rapid inflow(E), peak velocity of late diastolic inflow (A), A/E ratio, and deceleration time of E wave were measured by pulsed Doppler echocar diography. 1) LVangiogram was performed in 10 patients, and showed normal wall motion in 7 cases and regional hypokinesia in 3 cases. Delta area decreasing rate was 59+/-10%, and LVEDP was 11+/-4 mmHg. 2) A/E ratio was greater in patient group(1.00+/-0.28) than in normal control (0.64+/-0.10) (p<0.05). There was no significant difference in A and E values between two groups. 3) A/E ratio decreased significantly from 1.00+/-0.28(pre-PTCA) to 0.85+/-0.24 (late post-PTCA) (p<0.01), but there was no significant change at early post-PTCA(0.94+/-0.32). Deceleration time also decreased significantly from 213+/-56 msec(pre-PTCA) to 177+/-34 msec (late post-PTCA) (p<0.05), but there was no significant change at early post-PTCA (199+/-34 msec). In conclusion, there was impairment of left ventricular diastolic filling in patients with coronary artery disease which gradually improved after PTCA, and this result probably is related to post-ischemic "stunned" myocardium.
Angina, Unstable ; Angioplasty, Balloon, Coronary ; Arteries ; Coronary Artery Disease* ; Coronary Vessels* ; Deceleration ; Echocardiography, Doppler, Pulsed* ; Humans ; Hypokinesia ; Myocardium ; Sex Distribution

In order to analyze academic achievement of medical students and its related factors, a total of 2,371 students who entered the premedical course of O university from 1987 were reviewed based on cohor t of their admission year. Those who did not promoted to medical college from premedical course in two years were 15% and those who did not graduate medical school in four years were 21%. The percentage of female students and outside Seoul residents has been growing. The percentage that students parents' occupation is medical profession has been decreasing. Those who failed during premedical course have higher conditional probability to fail during the medical studies. The results suggest that medical educators pay more attention to those who failed during the premedical course. Also the criteria whether students are failed or promoted to next grade is reasonable should be studied in depth.
Cohort Studies* ; Female ; Humans ; Occupations ; Schools, Medical ; Seoul ; Students, Medical*

BACKGROUND: Progression of coronary artery disease(CAD) is highly unpredictable, and follows a nonlinear course. In previous reports, progression was related to acute myocardial infarction and cardiac death. The present study was designed to assess the characteristics of progression of CAD and to ditermine the predictors for progression. METHODS: The present study included 41 patients(age 55+/-9 years ; male/female=36/5) with CAD who underwent coronary angiography at least twice(interval : mean 26 months), and patients who underwent coronary angioplasty of coronary bypass surgery before the 2nd angiograms were excluded from analysis. The coronary arterial bed was divided into 15 segments according to American Heart Association(AHA) committee report. We measured both % stenosis and minimal diameter of the lesions, and divided the lesions into four Ambrose's morphological categories. Progression was considered to be present if one of the following changes had occurred : increase in % stenosis of lesions by> or =20%, decrease in minimal diameter by> or =0.5mm, or any new occlusion. For the purpose of detecting predictors we investigated clinical history(smoking, hypertension, obesity, and DM), angiographic findings(numbers of diseased vessels and lesions), and biochemical study (total cholesterol, LDL, HDL, triglyceride, uric acid, and albumin). RESULTS: Altogether, 32 patients(78%) showed progression, and regression was present in 11 patients(27%). Six patients had both progressed lesions and regressed lesions. Progression occurred most frequently in segments with stenosis of 1% to 25% at initial arteriogram. Progression occured in increasing order in proximal right coronary artery, mid-LAD, and proximal LAD. There was no significant differences in progression among four Ambrose's morphologic categories. 59(10%) of the analyzable 589 segments had progressed, 19 them upto occlusion, and 7 segments became infarct related artery. In 5(71%) of 7 cases of new myocardial infarction it occurred in segments with< or =75% stenosis at initial arteriogram. The analysis selected two independent predictors for progression: uric acid and numbers of lesions> or =20% stenosis. CONCLUSION: The present study suggests that progression of CAD occurred most frequently in minimally stenotic lesions and that about two thirds of acute myocardial infarction occurred from insignificantly stenotic lesion. Uric acid level and numbers of lesions> or =20% stenosis were selelcted as the independent predictors of coronary disease progression.
Angioplasty ; Arteries ; Cholesterol, LDL ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Death ; Heart ; Humans ; Hypertension ; Myocardial Infarction ; Obesity ; Research Report ; Triglycerides ; Uric Acid

PURPOSE: Calcium-activated potassium channels(KCa) may be involved in the transient outward current of the first phase of cardiac action potential. But it is still not clear whether cardiac myocytes express any Kca. We try to identify here the types of Kc, expressed in rat caridac myocytes. METHODS: We isolated total heart RNA from 50 rats(Spague-Dawley) and performed reverse transcription-polymerase chain reaction(RT-PCR) using specifically designed synthetic oligonucleotide primer sets. From the pure culture of cardiac myocyte, Kc, gene expression was detected by Southern blot analysis. RESULTS: RT-PCR revealed expressions of BKca(large-conductance Kca, rSlo) and S&,(small-conductance Kca, rSK1). We prepared cardiac myocytes pure culture(>9596 pure myocyte) using pure culture technique. RT-PCR and Southern blot analysis of rat cardiac myocyte showed only rSK1-specific band, but no rSlo-specific was detected. CONCLUSION: The expressions of more than one type of Kca are detected from rat heart. A sub-type of SKcrSK1, was expressed in cardiac myocyte, while the main subunit of BKca(rSlo) was found in cells other than myocytes, most likely in the smooth muscle of cardiac blood vessels.
Action Potentials ; Animals ; Blood Vessels ; Blotting, Southern ; Culture Techniques ; Gene Expression ; Heart ; Muscle Cells ; Muscle, Smooth ; Myocytes, Cardiac* ; Potassium ; Potassium Channels, Calcium-Activated* ; Rats* ; RNA

BACKGROUND: Reperfusion of ischemic myocardium has been postulated to result in a specific oxygen radical mediated tissue injury. Iron may liberate during ischemia and we hypothesized that administration of the iron chelator, deferoxamine during ischemia would result in improved recovery after postischemic reperfusion. PURPOSE: To test whether iron-catalyzed processes contribute to myocardial necrosis during ischemia and reperfusion, deferoxamine was administered to block iron catalyzed hydroxyl radical formation in rabbits. METHODS: Eleven rabbits were divided into two groups: control group (n=5) and deferoxamine pretreatment group (n=6). the left circumflex coronay artery was ligated for 30 minutes and reperfused for 180 minutes. Area at risk (AR) was measured by non-stained area with ethylene blue injection into left atrium after left circumflex coronary artery ligation. Infarct size was measured by weighing after tripheyltetrazolium chloride staining. Heart rate was measured using electrocardiographic recording and systemic blood pressure was monitored by pressure transducer connected to the catheter in the left ventricle. RESULTS: 1. There was no significant difference of heart rate and blood pressure in deferoxamine pretreatment group compared with control group. 2. There was significant decrease of serum iron concentration after continuous infusion of deferoxamine compared with serum iron concentration before ligation of coronary artery (P<0.05). 3. There was no significant difference of area at risk between control and deferoxamine pretreatment group. 4. Area at necrosis to area at risk was significantly reduced in deferoxamine pretreatment group compared with control group (P<0.05) The results suggest that deferoxamine infusion prior to coronary artery occlusion has a significant benefit in reducing infarct size in this model.
Arteries ; Blood Pressure ; Catheters ; Coronary Vessels ; Deferoxamine* ; Electrocardiography ; Heart Atria ; Heart Rate ; Heart Ventricles ; Hydroxyl Radical ; Iron ; Ischemia ; Ligation ; Myocardial Infarction* ; Myocardium ; Necrosis ; Oxygen ; Rabbits ; Reperfusion ; Transducers, Pressure

PURPOSE: All IgG subclasses such as IgG1, IgG2, IgG3 and IgG4 can be transferred from mother to fetus through the placenta, though the amount of each IgG subclass is different from one another. Maternally acquired immunity might have an important role for the protection against the infections. We studied transplacental passage of IgG subclasses. METHODS: In this study, we observed the transplacental passage of IgG-subclasses in 22 paired samples of maternal and full- term fetal cord sera. Gestational ages varied from 37 to 42 weeks. The concentrations of IgG subclasses were analyzed by radial immunodiffusion method using commercialized Human IgG Subclass Combi kit. RESULTS: The concentrations of IgG subclasses, IgG1, IgG3 and IgG4 in cord sera exceed the maternal concentration, while IgG2 did not. The ratio of serum levels of cord to maternal were 1.330+/-0.067 for IgG1, 0.859+/-0.039 for IgG2, 1.258+/-0.058 for IgG3 and 1.159+/-0.038 for IgG4. CONCLUSION: This result suggested that the placenta may play a selective barrier for passage of IgG2.
Fetus* ; Gestational Age ; Humans ; Immunity, Maternally-Acquired ; Immunodiffusion ; Immunoglobulin G* ; Mothers ; Placenta

Progression of coronary artery disease after angioplasty seemed to be an important determinant of the long term efficacy of percutaneous transluminal coronary angioplasty(PTCA). In fifty seven patients who underwent coronary angiography beyond 1 month of PTCA, progression of coronary artery disease was evaluated and clinical and angiographic variables that might predict the progression after PTCA were sought. At the time of the repeat study, restenosis(>50% loss of PTCA gained diameter or >50% diameter stenosis) was found in 35 patients(61%) and progression(increasing >20% obstruction in coronary diameter or newly occurred total occlustion) was found in 20 patients(35%). Progression occurred similarly both in patients with restenosis(12 of 3, 35%) and in patients without restenosis(8 of 22, 36%). Within 6 months of PTCA, restenosis was found in 82%(23 of 28) and progression in 36%(10 of 28) and beyond 6 months, restenosis in 41%(12 of 29) and progression in 34%(10 of 29). Progression tended to occur more commonly in the artery which was dilated(10 of 60,17%) than in the artery that was not dilated(10 of 111, 9%), but this observation did not reach statistical significance. The influence of the risk factors on the progression was evaluated and progression appeared to be correlated with the initial extent of coronary artery disease and high low-density lipoprotein/high-density lipoprotein cholesterol ratio at follow-up study. Furthermore, the low-density lipoprotein/high-density lipoprotein cholesterol ratio at follow-up study was significantly higher in patients with progression in nondilated artery than that of those without progression, but there was no significant difference between patients with progression in dilated artery and patients without progression. In this study, we found that the incidence of progression was not rare within 6 months of PTCA as beyond 6 months. In addition, the incidence of progression in dilated vessels was not significantly higher than that in nondilated vessels, but high low-density lipoprotein/high-density lipoprotein cholesterol ratio was associated only with progression in non-dilated vessels, so trauma in dilated artery during PTCA might predispose the patients with low risk to the progression of coronary artery disease. Conclusively, PTCA may accelerate the progression of coronary artery disease. And the consistent relation between PTCA and progression of coronary artery disease requires further evaluation with more patients and prospective protocol.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Arteries ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Incidence ; Lipoproteins ; Risk Factors

OBJECTIVES: To estimate the annual socioeconomic costs of stroke in Korea in 2005 from a societal perspective. METHODS: We identified those 20 years or older who had at least one national health insurance (NHI) claims record with a primary or a secondary diagnosis of stroke (ICD-10 codes: I60-I69, G45) in 2005. Direct medical costs of the stroke were measured from the NHI claims records. Direct non-medical costs were estimated as transportation costs incurred when visiting the hospitals. Indirect costs were defined as patients' and caregivers' productivity loss associated with office visits or hospitalization. Also, the costs of productivity loss due to premature death from stroke were calculated. RESULTS: A total of 882,143 stroke patients were identified with prevalence for treatment of stroke at 2.44%. The total cost for the treatment of stroke in the nation was estimated to be 3,737 billion Korean won (KRW) which included direct costs at 1,130 billion KRW and indirect costs at 2,606 billion KRW. The per-capita cost of stroke was 3 million KRW for men and 2 million KRW for women. The total national spending for hemorrhagic and ischemic stroke was 1,323 billion KRW and 1,553 billion KRW, respectively, which together consisted of 77.0% of the total cost for stroke. Costs per patient for hemorrhagic and ischemic stroke were estimated at 6 million KRW and 2 million KRW, respectively. CONCLUSIONS: Stroke is a leading public health problem in Korea in terms of the economic burden. The indirect costs were identified as the largest component of the overall cost.
Adult ; Aged ; Aged, 80 and over ; Female ; *Health Care Costs ; *Health Expenditures ; Humans ; Insurance Claim Review ; Korea ; Male ; Middle Aged ; Prevalence ; Socioeconomic Factors ; Stroke/*economics ; Young Adult