Economic Evaluation of Different Initial Treatments for Primary Open Angle Glaucoma: A Markov Model

PURPOSE: To perform an economic evaluation of the different treatment methods available for primary open-angle glaucoma in a Korean setting, including medication, selective laser trabeculoplasty, or surgery. METHODS: Three independent Markov chains were constructed for each treatment option to simulate treatment progress and to evaluate the total treatment costs for each initial strategy. The Markov chain consisted of different stages (5, 10, 20 stages), with each stage being one year. Assuming 1000 patients, a Monte Carlo simulation was iterated 1000 times to evaluate the cost of treatment over 5, 10 and 20 years. RESULTS: During the initial five years, medication as the initial treatment was the most expensive, whereas laser trabeculoplasty was the cheapest. After ten years, surgery became the cheapest treatment. In ten years, if the success rate of surgery is greater than 30.1%, it was more economic to choose surgery as the initial treatment. For laser trabeculoplasty, if the success rate was greater than 16.3%, laser treatment was more economical than was medication. Our model shows that only if the annual cost of medication decreases to 60,000 won or 55,000 won, then the cost of choosing medication as the initial treatment strategy will be more economical than that of laser therapy or surgery, respectively. CONCLUSIONS: The economic value of choosing laser therapy as the initial treatment strategy is the greatest over five simulated-years, whereas surgery had the greatest economic value over more than ten years.

A Case of Clonorchiasis Presenting with Acute Pancreatitis and Cholangitis / 대한소화기내시경학회지

Clonorchiasis is a parasitic disease that is often found in Japan, Korea, China, Hong Kong as well as in countries in Southeast Asia. The disease is caused by the ingestion of infected raw freshwater fish. The clinical manifestations depend on the number of flukes in a patient, the period of infestation, and the complications. In patients with a heavy infestation, extrahepatic bile duct, the gallbladder and even the pancreas are involved. We experienced a 62-year-old man who had a history of ingestion of raw freshwater fish and presented with acute pancreatitis and cholangitis. The pancreaticobiliary-associated clonorchiasis was successfully treated with endoscopic sphincterotomy, and praziquantel.

Sweet's syndrome during the treatment of acute promyelocytic leukemia with all-trans retinoic acid

All-trans retinoic acid (ATRA) is the standard induction treatment for acute promyelocytic leukemia (APL). Quite many ATRA-related side effects, including retinoic acid syndrome, were reported. So far, it has rarely been reported that Sweet's syndrome, characterized by fever, neutrophilia, painful erythematous cutaneous plaques, dense dermal infiltrates of mature neutrophils and rapid response to steroid therapy, is associated with ATRA. In the case that Sweet's syndrome associated with ATRA is found, physicians will have to face a great challenge over the possibility of infectious conditions. We present here a case of Sweet's syndrome associated with ATRA. A 35-year-old female with APL developed fever, painful erythematous cutaneous plaques on both cheeks, right wrist and both shins during induction chemotherapy with ATRA. A skin biopsy revealed a dense dermal infiltrate, consisting of mature neutrophils without vasculitis or cutaneous immunoglobulin deposits, which is compatible with Sweet's syndrome. Oral prednisone was administered and the lesions started to improve within 48 hours

Serum soluble IL-2 receptor levels following interferon and ribavirin combination therapy with chronic hepatitis C / 대한내과학회지

BACKGROUND: To evaluate the cellular immune response to interferon(IFN)-alpha and ribavirin combination therapy in patients with chronic hepatitis C, we monitored serum levels of soluble IL-2 receptor(sIL2R) before and after the therapy. METHODS: Serum sIL2R levels before and after the combination therapy were measured in 19 patients with chronic hepatitis C. IFN(3 MU/day, 3 times/week) and ribavirin 1000 mg/day were administered for 24 weeks to all patients. RESULTS: After the therapy, sIL2R levels were increased (before, 3.13 0.67 ng/m L, and after 4.08 2.13 ng/mL, p=0.059) but statistically insignificant(p>0.05). The patients were divided into two groups : the responder group who were negative for serum hepatitis C virus(HCV)-RNA after the therapy, and the non-responder group who were still positive for HCV-RNA after the therapy. Between these two groups, sIL2R levels before and after the therapy were not significantly different. The ratio of sIL2R levels before and after the therapy was calculated, although the ratio was higher in responder group, but there was no significant difference between the two groups(sIL2R after the therapy)/(sIL2R before the therapy) : 1.43 0.70 in the responder group and 1.04 0.28 in the nonresponder group, p=0.096). CONCLUSION: Although these results failed to demonstrate that sIL2R level was increased during the combination therapy in patients with hepatitis C, this study suggested that cytokines which mediate immune response may be involved in the pathogenesis of chronic heaptitis C virus infection.

A Case of Rectal Adenocarcinoma with Radiation Colitis / 대한소화기내시경학회지

Radiotherapy induced colorectal adenocarcinoma with radiation colitis after radiotherapy has been reported as a rare case. A patient with rectal adenocarcinoma as a late complication of pelvic irradiation for gynecological malignancy is reported. A 55-year-old woman with bloody diarrhea for 6 months was admitted. She received radiation therapy for carcinoma of cervix 21 years ago. Colonoscopic findings revealed a polypoid mass on rectosigmoid colon. Histopathologic examination of the polypectomy specimen disclosed adenocarcinoma. We reported herein a case of rectal adenocarcinoma with radiation colitis. The patient who had received pelvic irradiation should have close follow-up with colonoscopic study for the early detection of colorectal cancer.