ABSTRACT
PURPOSE: To evaluate the cost-utility based on the quantitative relationship between glaucoma follow-up and glaucoma progression. METHODS: The Markov model was constructed and analyzed to determine the cost-effectiveness of primary open-angle glaucoma. The Markov model set up a virtual cohort of Korean over 40 years of age with early glaucoma. The costs associated with glaucoma treatment were assessed from a social point of view, and the utility was calculated using the quality adjusted life years according to the glaucoma states. Glaucoma health status was divided into 5 stages (early, middle, late, unilateral, bilateral blindness). The transition probability was set in one direction from mild to severe, and the length of each cycle was set at one year. The incremental cost effectiveness ratio (ICER) was calculated and compared with each other different follow-up periods. Sensitivity analysis was conducted to determine how the uncertainty of the variables used in this study affected the outcome. RESULTS: ICER of 3-month follow-up was 28,244,398 won/quality adjusted life years (QALY) compared 6-month follow-up, and ICER of 6-month follow-up was 13,615,443 won/QALY compared to 12-month follow-up. If the probability of progression of glaucoma in 6-months follow-up observations increases by more than 10% over 3-month periodic follow-up and the progression probability of 12-month follow-up increases by more than 15% follow-up compared to 3-months follow-up, 3-months follow-up was found to be a cost-effective strategy. On the other hand, 6-month follow-up was found to be cost-effective if probability of progression of 6-month follow-up was less than 10% increase of 3-month follow-up and 15% increase of 6-months follow-up. CONCLUSIONS: Cost-effective follow-up strategies differed according to the probability of progression of glaucoma, and 3-month or 6-month follow-up strategies were cost-effective and acceptable in Korea's health care system.
Subject(s)
Cohort Studies , Cost-Benefit Analysis , Delivery of Health Care , Follow-Up Studies , Glaucoma , Glaucoma, Open-Angle , Hand , Quality-Adjusted Life Years , UncertaintyABSTRACT
PURPOSE: To evaluate the possible association between psychological stress and glaucoma, given that there are emerging issues and controversy regarding whether psychological stress is one of contributing factors of glaucoma development. METHODS: We used the medical records of 16,426 patients from the Korean National Health and Nutritional Examination Survey 2008–2011. Glaucoma was defined based on examinations including the intraocular pressure, optic disc, visual field, and retinal nerve fiber layer. Stress was evaluated using five questionnaires regarding sustained stress, depression, feelings of suicide, history of suicide attempt/s, and history of psychological counseling. We used univariable and multivariable logistic regression analyses after adjusting confounding factors for glaucoma. RESULTS: Univariable logistic regression analysis revealed no significant association between glaucoma and psychological stress (odds ratio [OR] = 0.84; confidence interval [CI] = 0.70–1.01), depression (OR = 1.22; CI = 0.97–1.55), suicide attempt/s (OR = 0.73, CI = 0.33–1.59), and psychological counseling (OR = 0.72, CI = 0.43–1.21). Using univariate analysis, only the feelings of suicide factor (OR = 1.28, CI = 1.02–1.60) was significantly associated with glaucoma. Using multivariable analysis after adjusting for confounding factors, no significant association was found in any psychological stress factor. CONCLUSIONS: There was no significant association between psychological stress and glaucoma. The results of this study indicated that the pathogenesis of glaucoma is more consistent with the pathogenesis of physiological causes such as age or hypertension, rather than indirect causes such as stress.
Subject(s)
Humans , Counseling , Depression , Glaucoma , Hypertension , Intraocular Pressure , Korea , Logistic Models , Medical Records , Nerve Fibers , Retinaldehyde , Stress, Psychological , Suicide , Visual FieldsABSTRACT
Gastric lymphoepithelioma-like carcinoma is a very rare cancer of the stomach. It has undifferentiated malignant cells with rich lymphoid stroma histologically and its prognosis has known to be relatively fair. Recently, there were some reports on the successful removal of the lesion by endoscopic submucosal dissection technique. We present a case of 70 years old man who had 2 cm sized early gastric cancer of lymphoepithelioma-like carcinoma with perigastric lymph node metastasis, and also review the relevant medical literature.
Subject(s)
Lymph Nodes , Neoplasm Metastasis , Prognosis , Stomach NeoplasmsABSTRACT
Henoch-Schonlein purpura (HSP) is a vasculitis of the small vessels of the skin, joints, gastrointestinal tract, and kidneys characterized by immunoglobulin A deposits in the involved organs. HSP is typified by the classic tetrad of purpura, arthralgia, abdominal pain, and renal involvement. It is common in childhood, but may also occur in adults and can be accompanied by severe complications. Gastrointestinal symptoms occur in up to 85% of patients, and gastrointestinal involvement can manifest as severe problems including intussusception, obstruction, and perforation. The disease course is often self-limited, but severe manifestations occasionally require surgical intervention. We report the case of a 24-year-old man with HSP who presented with abdominal pain and vomiting. Computerized tomography revealed thickening of the ileal wall and multifocal disrupted prominent mucosal enhancement. These findings suggested hemorrhagic enteritis and mucosal necrosis. After treatment with high dose corticosteroids, the lesion improved and surgical intervention was avoided. Our experience suggests that corticosteroid therapy may help in controlling HSP with suspicious small bowel necrosis.
Subject(s)
Adult , Humans , Young Adult , Abdominal Pain , Adrenal Cortex Hormones , Arthralgia , Enteritis , Gastrointestinal Tract , Immunoglobulin A , Intussusception , Joints , Kidney , Necrosis , Purpura , IgA Vasculitis , Skin , Steroids , Vasculitis , Vasculitis, Leukocytoclastic, Cutaneous , VomitingABSTRACT
PURPOSE: To investigate the clinical results of 44 high myopic eyes with cataracts which had minus diopter IOLs (Intraocular lenses) implanted during cataract surgery. METHODS: A retrospective chart review was done on 44 eyes in 33 patients who had undergone cataract extraction and minus diopter posterior chamber lens implantation. The IOL power was calculated using the SRK-T formula, and ACR6D SE(R) (Corneal SA, France) IOL was implanted in all cases. We evaluated pre-operative target refraction, post-operative refraction at six months, pre-operative visual acuity with and without correction, and post-operative visual acuity with and without correction. The relationships between axial length and refractive error and between the diopter of IOLs and refractive error were analyzed. RESULTS: The mean postoperative hyperopic refractive error compared to the preoperative target refraction was +1.04+/-1.05D, which was statistically significant (p<0.01). The longer the axial length and the larger the minus diopter lens inserted, the larger the hyperopic error. However, there were no statistically significant differences between them. CONCLUSIONS: Satisfactory results in visual acuity were obtained after cataract surgery in high myopic patients. However, when choosing the IOL power in high myopic patients, the possible development of postoperative hyperopic error should be considered.
Subject(s)
Humans , Cataract , Cataract Extraction , Eye , Lenses, Intraocular , Myopia , Refractive Errors , Retrospective Studies , Visual AcuityABSTRACT
PURPOSE: To present a case of bilateral retinal vasculopathy as the first manifestation of chronic myelogenous leukemia. CASE SUMMARY: A 59-year-old man with no medical history such as diabetes, hypertension and no ocular history complained of decreased visual acuity for 1 month. Fundus examinations showed diffuse multiple dot and blot hemorrhages over the panretina of both eyes and vessels showed tortuous vascular changes. The fluorescein angiogram was evaluated, and showed diffuse microaneurysms at the peripheral retina and posterior pole. Hematologic and biochemical examinations as well as a carotid sonogram were performed based on the possibility of systemic disease. The patient showed hematologic abnormality and therefore was transferred to internal medicine for diagnosis of chronic myelogenous leukemia. CONCLUSIONS: The authors examined a chronic leukemia patient, who showed bilateral retinal vasculopathy as the first manifestation of chronic myelogenous leukemia. This case shows the importance of considering the possibility of systemic disease.
Subject(s)
Humans , Middle Aged , Eye , Fluorescein , Hemorrhage , Hypertension , Internal Medicine , Leukemia , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Retina , Retinaldehyde , Visual AcuityABSTRACT
PURPOSE: To evaluate one-year clinical results of Crystalens(R) (AT-45, Eyeonics, CA, USA) accommodating IOL implantation. METHODS: In this retrospective study, 25 eyes of 18 patients had phacoemulsification and Crystalens(R) accommodating IOL implantation. Distance and near visual acuity (VA) during the 12-months were measured. RESULTS: At two months, uncorrected distance visual acuity (VA) of 13 eyes (52.0%) and 21 eyes (84.0%) were 20/25 and 20/40 or better, respectively. At six months, 11 eyes (44.0%) and 21 eyes (84.0%) were 20/25 and 20/40 or better, respectively. At 12 months, 11 eyes (44.0%) and 17 eyes (68.0%) were 20/25 and 20/40 or better, respectively. At two months, the uncorrected near VAs of 11 eyes (44.0%) and 17 eyes (68.0%) were 20/25 and 20/40 or better, respectively. At six months, 9 eyes (36.0%) and 16 eyes (64.0%) were 20/25 and 20/40 or better, respectively. After 12 months, 6 eyes (24.0%) and 16 eyes (64.0%) were 20/25 and 20/40 or better, respectively. CONCLUSIONS: The uncorrected near VAs gradually decreased with the passage of time until 12 months after Crystalens(R) accommodating IOL implantation.
Subject(s)
Humans , Eye , Lenses, Intraocular , Phacoemulsification , Retrospective Studies , Visual AcuityABSTRACT
PURPOSE: To evaluate one-year clinical results of Crystalens(R) (AT-45, Eyeonics, CA, USA) accommodating IOL implantation. METHODS: In this retrospective study, 25 eyes of 18 patients had phacoemulsification and Crystalens(R) accommodating IOL implantation. Distance and near visual acuity (VA) during the 12-months were measured. RESULTS: At two months, uncorrected distance visual acuity (VA) of 13 eyes (52.0%) and 21 eyes (84.0%) were 20/25 and 20/40 or better, respectively. At six months, 11 eyes (44.0%) and 21 eyes (84.0%) were 20/25 and 20/40 or better, respectively. At 12 months, 11 eyes (44.0%) and 17 eyes (68.0%) were 20/25 and 20/40 or better, respectively. At two months, the uncorrected near VAs of 11 eyes (44.0%) and 17 eyes (68.0%) were 20/25 and 20/40 or better, respectively. At six months, 9 eyes (36.0%) and 16 eyes (64.0%) were 20/25 and 20/40 or better, respectively. After 12 months, 6 eyes (24.0%) and 16 eyes (64.0%) were 20/25 and 20/40 or better, respectively. CONCLUSIONS: The uncorrected near VAs gradually decreased with the passage of time until 12 months after Crystalens(R) accommodating IOL implantation.
Subject(s)
Humans , Eye , Lenses, Intraocular , Phacoemulsification , Retrospective Studies , Visual AcuityABSTRACT
PURPOSE: To evaluate the efficacy and complication of minimally invasive plate osteosynthesis (MIPO) technique for lateral malleolar fracture. MATERIALS AND METHODS: From January 2001 to December 2003, we had treated 13 cases of lateral malleolar fracture (AO-OTA classification, type A: 4, type B: 9) by MIPO technique and followed them up more than 1 year. Operation time, union time, radiologic alignment, range of motion of the ankle joint, functional results according to criteria of Meyer and complication were evaluated. RESULTS: After the final follow-up, all the fractures were healed without any second procedure, full-weight bearing ambulation was started in average 10 weeks. Any malunion was not observed by the inadequate bending of plate. Two patients felt a discomfort of ankle because the location of plate was lower than the tip of the lateral malleolus, but all the patients had excellent or satisfactory ankle functions. No deep infection or soft tissue compromise were observed at the last follow up. CONCLUSION: Minimally invasive plate osteosynthesis technique is safe and worthwhile method in management of lateral malleous fractures while avoiding the complications associated with conventional open plating methods.
Subject(s)
Humans , Ankle , Ankle Fractures , Ankle Joint , Classification , Follow-Up Studies , Range of Motion, Articular , WalkingABSTRACT
PURPOSE: To evaluate the result of tibial shaft fractures in children treated with pin and plaster method. MATERIALS AND METHODS: From March 1998 to February 2003, Tibial shaft fractures in thirty six pediatric patients which were treated with pin and plaster method were clinically and radiologicaly evaluated retrospectively. RESULTS: Mean bony union duration was 9.8 weeks. All fractures healed within acceptable angulations. There was neither delayed union nor nonunion. There were complications related to the pins, including superficial and deep infection, skin sloughing. There were 7 cases of tibial overgrowth but they had no functional disability. CONCLUSION: Pin and plaster method can substitute other operative methods in tibial fractures in children which is difficult to reduce or maintain reduction by conservative treatment.
Subject(s)
Child , Humans , Retrospective Studies , Skin , Tibial FracturesABSTRACT
PURPOSE: To analyze the cause and treatment method of humerus nonunions which were initially treated by operation. The causes of nonunion were analyzed according to the initial treatment method. We report upon treatment options. MATERIALS AND METHODS: We reviewed 15 cases of humerus nonunion, which were initially treated surgically (7 cases of dynamic compression plate, 4 of Ender nail, 3 of interlocking intramedullary nail, 1 of K-wire) from January 1992 to January 2001. RESULTS: The causes of nonunion were determined to be as follows ; inadequate internal fixation or technical failure (9 cases), postoperatively applied improper external immobilization (5 cases), inadequate choice of implant (1 case). We treated the nonunion as follows; dynamic compression plate and bone graft in 11 cases, intramedullary nailing with small plate augumentation and bone graft in two, maintenance of initial nail with small plate augumentation and bone graft in two. All cases had bone union at an average of 15.9 weeks without complications, such as osteomyelitis, radial nerve palsy, or joint stiffness. CONCLUSION: Plate fixation is considered to be superior to intramedullary fixation in the treatment of nonunion. However, cases that received interlocking intramedullary nailing can be treated easily with small plate augumentation and bone graft without initial nail removal.
Subject(s)
Fracture Fixation, Intramedullary , Humerus , Immobilization , Joints , Osteomyelitis , Paralysis , Radial Nerve , TransplantsABSTRACT
PURPOSE: To characterize PTEN gene alterations and their expressions during the development of osteosarcoma. MATERIALS AND METHODS: We studied the pattern of deletion, mutation and expression of PTEN in normal bone tissues, tumor samples of 22 patients of osteosarcoma, and 4 osteosarcoma cell lines (HOS, U2-OS, MG-63 and Saos-2). The tissue was analyzed for deletion and mutational inactivation of PTEN by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and direct sequence analysis, and examined for abnormalities in expression by immunohistochemistry. RESULTS: In this study, neither mutation nor deletion of PTEN was found. Expression of PTEN protein was increased, without deletion or mutation of the PTEN gene, in 22 patients of osteosarcoma and in 4 osteosarcoma cell lines. Nuclear staining was more intense than the cytoplasmic staining in normal bone tissues and osteosarcoma cell lines, but in osteosarcoma tissues PTEN was expressed mainly in the cyto-plasm. CONCLUSION: These results suggest that abnormal expressions of PTEN by differential compartmentalization may play a role in the development and progression of osteosarcoma, instead of genetic alterations of PTEN.
Subject(s)
Humans , Bone and Bones , Cell Line , Cytoplasm , Immunohistochemistry , Osteosarcoma , PTEN Phosphohydrolase , Sequence AnalysisABSTRACT
PURPOSE: The purpose of our study was to determine the effectiveness of primary repair of arcuate ligament complex in posterolateral rotary instability of knee. MATERIALS AND METHODS: We reviewed the clinical records and operative notes of 9 patients who were treated by primary repair for the acute posterolateral rotary instability and followed more than 1 year. All the 9 knees had a positive external rotation recurvatum test and a positive posterolateral drawer test, One or more components of the arcuate ligament complex were injured in all cases and associated injuries were posterior cruciate ligament rupture in 6, lateral collateral ligament in 5, anterior cruciate ligament partial rupture in 2, biceps femoris rupture in 2, meniscus tear in 3, iliotibial band rupture in 1, ipsilateral femur fracture in 1 and peroneal nerve palsy in 1. RESULTS: By objective rating index, the results were classified as good (4 patients), fair (4 patients) and poor (1 patient). By functionally, the results were classified as good (6 patients), fair (3 patients). CONCLUSIONS: Consequently, we believe that primary repair of arcuate ligament complex in acute stage can result in objectively and functionally acceptable knee function.
Subject(s)
Humans , Anterior Cruciate Ligament , Femur , Knee , Lateral Ligament, Ankle , Ligaments , Paralysis , Peroneal Nerve , Posterior Cruciate Ligament , RuptureABSTRACT
PURPOSE: The purpose of our study is to evaluate the diagnostic significance of clinical findings, WBC count, ESR, CRP, simple X-ray, ultrasonography and bone sanning in neonates. MATERIALS AND METHODS: From January 1995 to May 1998, we have experienced 14 cases of pyogenic osteomyelitis and pyogenic arthritis in neonates. The mean age of patients was 16.7 days and the involved sites were 6 cases of pyogenic arhtritis of hip, 5 cases of pyogenic arthritis of hip with proximal femur osteomyelitis, 2 cases of pyogenic arthritis of shoulder with proximal humerus osteomyelitis and 1 case of proximal tibia osteomyelitis. RESULTS: The most frequent clinical signs were local swelling and pseudoparalysis of involved extremity. Laboratory findings showed that elevated ESR was in 11/14 (79%), positive CRP in 6/8 (75%), leukocytosis in 6/14 cases (43%). Abnomal findings in simple X-ray was in 7/13 (54%), positive bone scanning findings in 3/8 (37.5%), positive ultrasonographic findings in 11/11 cases (100%). CONCLUSIONS: ITherefore we concluded that careful physical examination and ultrasonography were important for early diagnosis of bone or joint infection in neonates
Subject(s)
Humans , Infant, Newborn , Arthritis , Diagnosis , Early Diagnosis , Extremities , Femur , Hip , Humerus , Joints , Leukocytosis , Osteomyelitis , Physical Examination , Shoulder , Tibia , UltrasonographyABSTRACT
Entrapment syndrome of suprascapular nerve by a ganglion has been reported not frequently. We experienced a case of suprascapular nerve entrapment by ganglion which was treated with non-operative treatment, and report it with literature.
Subject(s)
Ganglion Cysts , Nerve Compression SyndromesABSTRACT
Local anesthesia for arthroscopic procedure of the knee is an increasinglv popular technique that avoids the use of general anesthesia and the associated risks of respiratory depression, aspiration, and postoperative sedation. Many authors, for example McGinty etc., Martin, Yoshiya etc., advocated local anesthesia as safe and efficient method for arthroscopic procedures of the knee. We performed arthoroscopy of the knee under local anesthesia on 150 patients for diagnostic and operative purposes between January l993 and December l996. The technique of local anesthesia that we used was that 20cc of 0.5%; bupivacaine with I:200,000 epinephrine was injected into superolateral portal of the knee joint and additional 10-20cc ot 1% lidocaine into the arthroscopic portals. Pnevmatic tourniquet wa, not applied in all cases. We analysed the 150 cases and the results were as follows; The diagnostic arthroscopy was performed in 50 cases and the operative arthroscopy was in 100 cases. The duration ot local anethesia was from 4 hours to 12 hours, with an average of 6 hours. In 35 cases arthroscopy was performed as outpatient procedure and average hospital stay excluding other problem was 5 days. No complication related to systemic toxicity by local anesthetics was observed. Conclusively arthroscopy of the knee under local anesthesia is safe and effective procedure to avoid the risks of general anesthesia but patients selection is very important.
Subject(s)
Humans , Anesthesia, General , Anesthesia, Local , Anesthetics, Local , Arthroscopy , Bupivacaine , Epinephrine , Knee Joint , Knee , Length of Stay , Lidocaine , Outpatients , Respiratory Insufficiency , TourniquetsABSTRACT
External fixation is regarded as the treatment of choice for type 2 and 3 open tibial fractures. However, external fixation alone, especially of an unstable fracture, can be complicated by high incidence of malunion, delayed union, loss of reduction, refracture, and pin-tract infection. Some surgeons tried to treat such problems by secondary intramedullary nailing, but they came to different results. The purpose of the present study is to eveluate our experience with secondary intramedullary nailing after external fixation of 6 cases of type 3B open tibia fractures and 1 case of type 3B femur fracture. These cases were followed for more than 13 months and the following results were obtained. 1. The external fixation had been maintained for an average of 62 days. 2. The mean interval between removal of the external fixator and intramedullary nailing was 23 days. 3. Antibiotics was injected for 2 weeks after removal of external fixator. 4. Reamed intramedullary nailing with static interlocking were done in all 13 cases. 5. Deep infections developed in 2 cases, one case which had been pin-tract infection was around intramedullary nail and the other in fracture site. 6. All cases were healed ultimately and average union time after nailing was 9 months.