• International Journal of Heart Failure
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• v.6 no.2
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• pp.56-69
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• 2024

Background and Objectives: The number of people with heart failure (HF) is increasing worldwide, and the social burden is increasing as HF has high mortality and morbidity. We aimed to provide updated trends on the epidemiology of HF in Korea to shape future social measures against HF. Methods: We used the National Health Information Database of the National Health Insurance Service to determine the prevalence, incidence, hospitalization rate, mortality rate, comorbidities, in-hospital mortality, and healthcare cost of patients with HF from 2002 to 2020 in Korea. Results: The prevalence of HF in the total Korean population rose from 0.77% in 2002 to 2.58% (1,326,886 people) in 2020. Although the age-standardized incidence of HF decreased over the past 18 years, the age-standardized prevalence increased. In 2020, the hospitalization rate for any cause in patients with HF was 1,166 per 100,000 persons, with a steady increase from 2002. In 2002, the HF mortality was 3.0 per 100,000 persons, which rose to 15.6 per 100,000 persons in 2020. While hospitalization rates and in-hospital mortality for patients with HF increased, the mortality rate for patients with HF did not (5.8% in 2020), and the one-year survival rate from the first diagnosis of HF improved. The total healthcare costs for patients with HF were approximately $2.4 billion in 2020, a 16-fold increase over the $0.15 billion in 2002. Conclusions: The study's results underscore the growing socioeconomic burden of HF in Korea, driven by an aging population and increasing HF prevalence.

• The Korean Nurse
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• v.36 no.1
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• pp.59-76
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• 1997

The purposes of this study were to identify the contents and satisfaction level of the patients received home care service, and to compare the differences of the contents by the characteristics of the patients. Seventy eight patients received home care service from 1st Jan. to 30th Sept., 1996 were data-collected to analyze the contents and outcomes of home care service. Sixty-nine patients currently receiving home care service were participated to evaluate the satisfaction level of home care service. The data were analyzed using mean, standard deviation, $x^2$ test, and ANOVA by SPSS $PC^+$ program. The findings of this study were as follow : 1. The contents & outcomes of home care service 1) The mean age of the subjects was 64.4 years: 58% of them were female. Those who living in Seoul were 83% and the rest of the subjects was living in Kyung-Gi. 2) The subjects who had one diagnosis were 41%. Over 60% of them had the disease of neurologic & sensory system. 3) The mean number of visit was 6. Only one visit was 22%. The mean time of care was 79 minutes. Duration of visit from 31 minutes to 60 minutes were 47 %. The subjects who terminated the visit because of death were 67.3%. 62% of the persons who referred them to the home care service were nurses. 4) The pain after the service was more relieved than before. The amounts of intake, the degree of bed sore, edema & fracture after the service were more improved than before. Health status after the service was improved in general. 5) There were significant differences between initial and last conscious level in tracheostomy care & oxygen inhalation care. There was significant difference between initial and last degree of activity in blood sugar check. 6) There were significant differences on the number of visit in assessment of the status, evaluation & observation, vital sign check, skin care, injection, medication, bed sore care, colostomy care, relaxation therapy for pain relief, patient education, family care, exercise therapy, position change, supply of disinfected equipments and infection control. There were significant differences on visiting time in nasogastric tube care, drainage tube care and oxygen inhalation care. 2. The satisfaction level of home care service 1) 50% were male. Over 60 years of the subjects was 61 %. Those who living in Seoul were 82%. 2) The subjects who had one or two diagnosis were 32% respectively. 55% of the persons who referred them to the home care service were nurses. 3) Total level of satisfaction of home care service was very high. 4) The older the age, the higher the satisfaction level. The larger the number of visit, the higher the satisfaction level. 5) The subjects who were in cloudy state were higher level of satisfaction than in alert or coma state. The subjects whose activity were normal or who needed assistance were higher level of satisfaction than bedridden or immobilized subjects. These findings suggested that the patients had substantial need for posthospital care. They tended to be elderly and to have experienced the wide range of health problems associated with aging, chronicity, including limitations in activities, and other serious health problems. So, the nationwide home care systems beyond the limit of demonstration program by local association and the development of the effective financial system of home based health care are necessary for the clients who are in need of home care.

• The Korean Journal of Nuclear Medicine Technology
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• v.18 no.1
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• pp.49-61
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• 2014

Purpose: With the aging of the population, the attack rate of osteoporotic vertebral compression fracture is in the increasing trend, and percutaneous vertebroplasty (PVP) is the most commonly performed standardized treatment. Although there is a research report of the excellence of usefulness of the SPECT/CT examination in terns of the exact diagnosis before and after the procedure, the bone cement material used in the procedure influences the image quality by forming an artifact in the CT image. Therefore, the objective of the research lies on evaluating the effect the bone cement gives to a SPECT/CT image. Materials and Methods: The images were acquired by inserting a model cement to each cylinder, after setting the background (3.6 kBq/mL), hot cylinder (29.6 kBq/mL) and cold cylinder (water) to the NEMA-1994 phantom. It was reconstructed with Astonish (Iterative: 4 Subset: 16), and non attenuation correction (NAC), attenuation correction (AC+SC-) and attenuation and scatter correction (AC+SC+) were used for the CT correction method. The mean count by each correction method and the count change ratio by the existence of the cement material were compared and the contrast recovery coefficient (CRC) was obtained. Additionally, the bone/soft tissue ratio (B/S ratio) was obtained after measuring the mean count of the 4 places including the soft tissue(spine erector muscle) after dividing the vertebral body into fracture region, normal region and cement by selecting the 20 patients those have performed PVP from the 107 patients diagnosed of compression fracture. Results: The mean count by the existence of a cement material showed the rate of increase of 12.4%, 6.5%, 1.5% at the hot cylinder of the phantom by NAC, AC+SC- and AC+SC+ when cement existed, 75.2%, 85.4%, 102.9% at the cold cylinder, 13.6%, 18.2%, 9.1% at the background, 33.1%, 41.4%, 63.5% at the fracture region of the clinical image, 53.1%, 61.6%, 67.7% at the normal region and 10.0%, 4.7%, 3.6% at the soft tissue. Meanwhile, a relative count reduction could be verified at the cement adjacent part at the inside of the cylinder, and the phantom image on the lesion and the count increase ratio of the clinical image showed a contrary phase. CRC implying the contrast ratio and B/S ratio was improved in the order of NAC, AC+SC-, AC+SC+, and was constant without a big change in the cold cylinder of the phantom. AC+SC- for the quantitative count, and AC+SC+ for the contrast ratio was analyzed to be the highest. Conclusion: It is considered to be useful in a clinical diagnosis if the application of AC+SC+ that improves the contrast ratio is combined, as it increases the noise count of the soft tissue and the scatter region as well along with the effect of the bone cement in contrast to the fact that the use of AC+SC- in the spine SPECT/CT examination of a PVP performed patient drastically increases the image count and enables a high density of image of the lesion(fracture).

• Health Policy and Management
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• v.27 no.4
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• pp.273-275
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• 2017

It has been forty years since the implementation of National Health Insurance (NHI) in South Korea. Following the 1977 legislature mandating medical insurance for employees and dependents in firms with more than 500 employees, South Korea expanded its health insurance to urban residents in 1989. Resultantly, total expenses of the National Health Insurance Service (NHIS) have greatly increased from 4.5 billion won in 1977 to 50.89 trillion won in 2016. With multiple insurers merging into the NHI system in 2000, a single-payer healthcare system emerged, along with separation policy of prescribing and dispensing. Following such reform, an emerging financial crisis required injections from the National Health Promotion Fund. Forty years following the introduction of the NHI system, both praise and criticism have been drawn. In just 12 years, the NHI achieved the fastest health population coverage in the world. Current medical expenditure is not high relative to the rest of the Organization for Economic Cooperation and Development. The quality of acute care in Korea is one of the best in the world. There is no sign of delayed diagnosis and/or treatment for most diseases. However, the NHI has been under-insured, requiring high-levels of out-of-pocket money from patients and often causing catastrophic medical expenses. Furthermore, the current environmental circumstances of the NHI are threatening its sustainability. Low birth rate decline, as well as slow economic growth, will make sustainment of the current healthcare system difficult in the near future. An aging population will increase the amount of medical expenditure required, especially with the baby-boomer generation of those born between 1955 and 1965. Meanwhile, there is always the problem of unification for the Korean Peninsula, and what role the health insurance system will have to play when it occurs. In the presidential election, health insurance is a main issue; however, there is greater focus on expansion and expenditure than revenue. Many aspects of Korea's NHI system (1977) were modeled after the German (1883) and Japanese (1922) systems. Such systems were created during an era where infections disease control was most urgent and thus, in the current non-communicable disease (NCD) era, must be redesigned. The Korean system, which is already forty years old, must be redesigned completely. Although health insurance benefit expansion is necessary, financial measures, as well as moral hazard control measures, must also be considered. Ultimately, there are three aspects that we must consider when attempting redesign of the system. First, the health security system must be reformed. NHI and Medical Aid must be amalgamated into one system for increased effectiveness and efficiency of the system. Within the single insurer system of the NHI must be an internal market for maximum efficiency. The NHIS must be separated into regions so that regional organizers have greater responsibility over their actions. Although insurance must continue to be imposed nationally, risk-adjustment must be distributed regionally and assessed by different regional systems. Second, as a solution for the decreasing flow of insurance revenue, low premium level must be increased to an appropriate level. Likewise, the national reserve fund (No. 36, National Health Insurance Act) must be enlarged for re-unification preparation. Third, there must be revolutionary reform of benefit package. The current system built a focus on communicable diseases which is inappropriate in this NCD era. Medical benefits must not be one-time events but provide chronic disease management. Chronic care models, accountable care organization, patient-centered medical homes, and other systems that introduce various benefit packages for beneficiaries must be implemented. The reimbursement system of medical costs should be introduced to various systems for different types of care, as is the case with part C (Medicare Advantage Program) of America's Medicare system that substitutes part A and part B. Pay for performance must be expanded so that there is not only improvement in quality of care but also medical costs. Moreover, beneficiaries of the NHI system must be aware of the amount of their expenditure through a deductible payment system so that spending can be profiled and monitored. The Moon Jae-in Government has announced its plans to expand the NHI system; however, it is important that a discussion forum is created so that more accurate analysis of the NHI, its environments, and current status of health care system, can take place for reforming NHI.

• Journal of Korean Academy of Nursing
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• v.30 no.1
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• pp.122-136
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• 2000

Chronic illness requiring attention and management during a long period of time puts great burden onto patients, their family and society. For patients with chronic illnesses, providing social support is the most important, and the fundamental support comes from their spouses. Amount and quality of support from spouses seems to differentiated according to the sex of patients. Female patients tend to believe that their spouses are not very supportive. Therefore, the researchers assessed the burden of husbands of female arthritis patients to discover the factors that result in greater burden. Also, they developed a theoretical model of husbands′ care for their wives through a qualitative research into husbands′ experience. Method 1: The study material was 650 female arthritis patients registered in an arthritis clinic. The questionnaire about the disease experience of female arthritis patients and the burden of husbands were sent. Returned questionnaires numbered 210(32.3%) and 27 were excluded because of inadequate answers. The remaining 183 questionnaires were analyzed. The mean age of the patients was 51 years and the mean age of spouses was 55 years. The mean marital period was 28 years. The average duration since diagnosis was 9.1 years. Education level was varied from primary school to graduate school, and average income/month was 1,517,300 won. Method 2: Initial questionnaire studies on the burden of husbands were performed. Among 183 responding husbands, 23 consented to participate for a qualitative research. Data was obtained by direct and telephone interviews. The mean age of participants was 58 years, and the educational level and socioeconomic status also varied. Result: 1. Husbands′ burden: The average burden was 57.68 with a range of 6-96. 2. Burden and general characteristics: The husband′s burden correlated with the age of the patients, numbers in the family, therapy methods, patient′s level of discomfort, patient′s disease severity, patient′s level of dependence and the husband′s understanding of the level of severity. 3. Linear correlation analysis on burden: The husbands′ burden is explained in 22.5% by husband′s recognition of level of severity and husbands′ age. 4. There were four patterns of the burden on husbands: both objectve burden and subjective burden were high(pattern I), both of objectve burden and subjective burden were low(pattern II), objective burden was high but subjective burden was low(pattern III), objective burden was low but subjective burden was high(pattern IV). The pattern was correlated with the family income, educational level of the patients and their husbands, therapy methods, patient′s level of discomfort, patient′s disease severity, patient′s level of dependence and husband′s understanding of level of severity. 5. The core category of the caring experience of the husbands with arthritis patients was "companionship". The causal factor was the patients′ experience due to symptoms : physical disfigurement, pain, immobility, limitation of house chores, and limitation of social activities. Contextural factors are husbands′ identification of housework and husbands′ concern about the disease. The mediating factors are economic problems, fear of aging, feeling of limitation and family support. The strategy for interaction is mind control and how to solve emotional stress. The "companionship" resulted from caring activities, participation of household activities, helping patients′ to coping with emotional experience. 6. Companionship is established through the process of entering intervention, and caring state of mind. Entering intervention is the phase of participation of therapy and involvement of houseworks. The caring phase consists of decision on therapy, providing therapy, providing direct care, and taking over the household role of wife. Through caring phase, the changing phase set a stage in which husbands consolidate the relationship with their wives, and are reminded of the meaning of marriage. As a result, in changing phase, husbands′ companionship is enhanced. In conclusion, nursing care of chronic illnesses should include a family member especially the spouse. All information on disease shoud be provided to patients and whole family member. Strong support should also be provided to overcome difficulties in taking over role of other sex. Then the quality of life of patients and families will be much improved.

• 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.

• Korean Journal of Veterinary Service
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• v.42 no.4
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• pp.227-236
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• 2019

The complete blood count and serum biochemical parameters are essential tools for diagnosis and monitoring of physiological and disease conditions in dogs. These parameters may be affected by the breed and age of dogs. This study aimed to compare the changes of complete blood count and serum biochemical parameters according to the increasing age in 156 Sapsarees. In this study, the Sapsarees were clustered into ten age groups: four to six months, seven to nine months, ten to twelve months, one year, two years, three to four years, five to six years, seven to eight years, nine to ten years, and, eleven to twelve years old. In the result of the complete blood count, the total red blood cell count (P<0.001), hematocrit (P<0.001), and hemoglobin (P<0.001) values were significantly increased from 4~6 months to 2 years old Sapsarees. While the mean corpuscular volume (P<0.001) and mean corpuscular hemoglobin (P<0.001) values were significantly increased from 4~6 months to 3~4 years old. The mean corpuscular hemoglobin concentration was significantly (P=0.037) increased from 4~6 to 10~12-month-old Sapsarees. Total white cell count was significantly (P<0.001) decreased from 1 year to 9~10 years old. The result of differential white blood cell count showed that neutrophil count was significantly (P<0.001) increased from the age 4~6 months to 11~12 years old Sapsarees, whereas, lymphocyte (P<0.001), monocyte (P<0.001), and eosinophil (P=0.042) counts were significantly decreased from 7~9 months to 7~8 years, 4~6 months to 9~10 years, 3~4 to 5~6 years old, respectively. In the serum biochemistry result, the creatinine concentration was significantly (P<0.001) increased from 4~6 to 10~12 months, but significantly (P=0.006) decreased from 7~8 to 10~12 years old. Phosphate concentration was significantly (P<0.001) decreased from 3~4 to 9~10 years old, but significantly (P=0.021) increased from 9~10 to 11~12 years old. Calcium concentration significantly (P<0.001) decreased from 10~12 months to 11~12 years old. Total protein concentration significantly (P<0.001) increased from 4~6 months to 2 years old. While concentrations of albumin (P=0.004) and globulin (P<0.001) was significantly increased from 4~6 months to 3~4 years old, and from 4~6 months to 11~12 years old, respectively. The alkaline phosphate concentration was significantly (P<0.001) decreased from 4~6 months to 2 years old. We found that there are differences in the hematological parameters in relation with the increasing age in Sapsaree breed.

• Radiation Oncology Journal
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• v.14 no.3
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• pp.211-219
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• 1996

Purpose : Hysterectomy without lymph node dissection was considered an inadequate treatment method for invasive uterine cervix cancer. Usually the procedure was performed inadvertently on patients who were thought to have benign or premalignant conditions preoperatively. We analysed radiotherapy results of such patients to evaluate survival rates, failure patterns and prognostic factors according to various conditions. Materials and Methods : Sixty one patients undergoing hysterectomy in the presence of invasive cervical carcinoma were reviewed retrospectively. Preoperative diagnosis were carcinoma in situ (38 cases), severe dysplasia (2), myoma (6), uterine bleeding (4), uterine prolapse (2). and early invasive cervix cancer (10) (One patient had myoma and carcinoma in situ coincidently). Patients received postoperative megavoltage radiotherapy from August 1985 to December 1993, and minimum follow-up period was 24 months. Eight patients received ICR only, 6 patients ICR and external radiation, and 47 patients received external radiation therapy only. Results : Overall 5-year survival rate and relapse-free survival rate werer $83.8\%$, $86.9\%$ respectively. For patients with retrospective stage IA, IB, IIB (gross residual after surgery), and vaginal cuff recurrence were $90.9\%$, $88.8\%$, $38.4\%$, and $100\%$ respectively There were 8 cases of treatment failure, most of them (5/8) were in patients with gross residual disease, other patients were full thickness involvement of cervix wall (2/8) except one. Patients with early vaginal cuff recurrence and microinvasive cervical cancer (stage IA) had no treatment related failure Prognostic factors affecting survival by univariate analysis were status of residual disease, tumor histology and retrospective stage. Conclusion : Adjuvant radiotherapy appeared to be effective treatment method for patients with presumed stage IA, IB and early local recurrent disease after inadvertent hysterectomy Survivals for patients with gross disease remained after inappropriate hysterectomy was poor, So, early cancer detection and Proper management with precise pretreatment s1aging is necessary to avoid inadherent hysterectomy especially in the cases of gross residual disease.

• Journal of Oral Medicine and Pain
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• v.30 no.2
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• pp.239-246
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• 2005

The purpose of this study was to examine the difference of condylar and ramal vertical asymmetric indices on paonramic radiographs between temporomandibular disorder patients and normal group and according to classification of temporomandibular disorders. One hundred and twenty temporomandibular disorder patients and thirty normal individuals were selected. After tracing the panoramic radiographs, measurements for asymmetric indices were identified. The means and standard deviations of the measurement of each group were calculated and compared between two groups. Through the comparison of the measurement between two groups, following results were obtained 1. As a result of comparing condylar and ramal vertical asymmetry indices of the temporomandibular disorder patients with that of normal group, there was significant difference in condylar vertical asymmetry index between two groups and no significant difference in ramal vertical asymmetry index between two groups. 2. Condylar and ramal vertical asymmetry indices of temporomandibular joint disorder and muscle disorder patients showed greater value than normal group, but there was no significant difference between temporomandibular joint disorder patients and muscle disorder patients. 3. Among temporomandibular joint disorder patients, muscle disorder patients, and normal group, there was only significant difference in condylar vertical asymmetry index between temporomandibular joint disorder patients and normal group. 4. Among disc displacement, disc dislocation with reduction, and disc dislocation without reduction, there were no significant difference in condylar and ramal vertical asymmetry indices. 5. There were no correlation between aging and condylar and ramal vertical asymmetry indices. The results of the present study showed that condylar vertical asymmetry index of temporomandibular disorder patients showed greater values than normal group, and this difference could be considered as the features of temporomandibular disorders. Thus measuring the condylar vertical asymmetry index on panoramic radiographs is considered as the important factor for diagnosis and treatment of temporomandibular disorders.

• Radiation Oncology Journal
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• v.16 no.4
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• pp.441-446
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• 1998

Purpose : The incidence of esophageal carcinoma is increasing. Radical surgery is the treatment of choice, but large proportion of the esophageal cancer patients are with unresectable disease at the time of initial diagnosis, so radiation therapy has been the major treatment modality. We carried out retrospective analysis to see the outcome and prognostic factors of radiation therapy alone for esophageal carcinoma. Methods and Materials : From June of 1979 through December 1992, 289 patients with esophageal carcinoma were treated with radiation therapy alone at Department of Therapeutic Radiology, Seoul National University Hospital. Of these patients, 84 patients were excluded as they were ineligible for the current analyses. Twenty-two patients had distant metastasis other than supraclavicular lymph node metastasis, 52 patients received less than 45 Gy, and 10 patient were lost from follow-up. Therefore 205 patients constituted the base population of this study. According to AJCC s1aging system, there were 2 patients with stage 1, 104 with stage IIA, 26 with stage IIB, 48 with stage III, and 25 with stage IV Radiation dose ranged from 4500 cGy to 6980 cGy with median dose of 5940 cGy. Follow-up period of the alive patients ranged from 77 to 180 months. Results : The Median survival period of all the patients was II months and the 2-, 5-, and 10-year overall survival rates were 22.4$\%$, 10.2$\%$ and 5.3$\%$, respectively. Most of the failures were local recurrences. Of 169 failures, 134 had local failure as a component and 111 had local recurrence only. The Lymph node was most common distant metastatic site and the next was the lung. The stage, T-stage, N-stage, functional status, tumor size, and aim of treatment were statistically significant prognostic factors for survival by univariate analyses. But only tumor size and N-stage were significant by multivariate analyses. Conclusion : We could get 10.2$\%$ of 5 year survival rate and 5.3$\%$ of 10 year survival rate with radiation therapy alone. The size of tumor and N-stage were statistically significant prognostic factors for survival on multivariate analyses.