Calculation of Socioeconomic Cost of Depression in Korea in 2019 / 생물치료정신의학

Objectives@#：The high lifetime prevalence of depression in Korea is related to problems such as suicide and decreased productivity, as well as the cost of disease due to increased use of medical services, which can cause great socioeconomic loss. Therefore, in this study, the burden of disease of depression and the importance of managing mental health diseases, which are increasing day by day, are suggested to be helpful in determining priorities in health policy establishment. @*Methods@#：In this study, the socio-economic cost of depression was calculated by dividing it into direct cost and indirect cost. For statistical data, data from the National Health Insurance Service of the public and statistics on diseases of national interest were mainly used. @*Results@#：As a result, the socio-economic cost of depression in 2019 estimated in this study was calculated to be a total of KRW 4.83 trillion, with direct costs 692.9 billion won and indirect costs 4.13 trillion won. Among them, the cost due to decrease in work performance accounted for the largest portion, accounting for 65.5%. @*Conclusions@#：As the socio-economic burden due to depression is expected to increase in the future, it is necessary to establish a systematic funding plan for the treatment and management of depressed patients in daily life.

Scleral Buckling and Primary Vitrectomy in Simple Rhegmatogenous Retinal Detachment

PURPOSE: To compare the outcomes of scleral buckling (SB) and primary pars plana vitrectomy (PPV) for treatment of simple rhegmatogenous retinal detachment (RD). METHODS: One hundred and fifteen Eyes undergoing SB or PPV for the treatment of simple rhegmatogenous RD were prospectively identified and followed up at least six months. Anatomic results, functional outcomes and complications were compared between eyes treated with SB and eyes treated with PPV. RESULTS: We detected no significant differences in overall success rates or final vision quality between the two treatment groups. However, the final vision quality of pseudophakic patients treated with PPV was significantly better than the final vision quality of pseudophakic patients treated with SB. Two treatment goups experienced similar rates of intraocular pressure elevation and proliferative vitreoretinopathy development. In phakic patients, the rates of cataract progression were higher in patients treated with PPV than in patients treated with SB. CONCLUSIONS: PPV can be an effective method for the treatment of simple rhegmatogenous RD, and maybe considered as a viable alternative to SB for simple cases. However, in phakic patients treated with PPV, simultaneous or follow-up cataract surgery should be considered as adjuvant treatments.

Incidence and Characteristics of Acute Endophthalmitis Associated With Intravitreal Injection

PURPOSE: To evaluate the incidence, causative organism, clinical features, and visual outcomes of acute endophthalmitis following intravitreal injection. METHODS: For all intravitreal triamcinolone acetonide, bevacizumab, and lucentis injections performed in our outpatient clinic between January 2006 and June 2008, the number of injections, indications, type of administered drugs, and method of injection were investigated. The medical records of the patients with acute endoththalmitis were reviewed retrospectively. RESULTS: The total number of intravitreal injections was 10,153. The incidence of acute endophthalmitis for all intravitreal injections was 0.020% (2/10,153) with 0.030% (1/3,383) for the triamcinolone acetonide, 0.015% (1/6,552) for the bevacizumab, and 0.000% (0/218) for the ranibizumab drug injections. Streptococcus species were confirmed in the bacterial culture of two eyes with acute endotphthalmitis. After early vitrectomy and intravitreal antibiotics injection, one eye maintained vision but the other eye developed phthisis. CONCLUSIONS: Although the incidence of acute endophthalmitis following intravitreal injections performed in outpatient clinics is very low, due to the potentially fatal visual outcome after endophthalmitis, careful attention to aseptic injection technique is mandatory.

A Combination of 23-gauge and 20-gauge Transconjunctival Sutureless Vitrectomy

PURPOSE: To describe the clinical experience and safety profile of a combination of 23-gauge and 20-gauge transconjunctival sutureless vitrectomy (TSV) METHODS: Thirty-seven eyes of thirty-seven consecutive patients who underwent 23-gauge combined with 20-gauge transconjunctival vitrectomy surgery by a single surgeon from August 2006 through December 2006 were reviewed retrospectively for surgical indications, wound problems, and postoperative complications. RESULTS: Thirty-seven eyes, including eyes with proliferative diabetic retinopathy (n=24), macular hole (n=3), epiretinal membrane (n=3), vitreous hemorrhage due to branch retinal vein occlusion and choroidal neovascular membrane (n=3), vitreous opacity secondary to uveitis (n=1), rhegmatogenous retinal detachment (n=1), and vitreoretinal traction syndrome (n=1), underwent operation. Seven eyes at 23-gauge sclerotomy sites and 15 eyes at 20-gauge sclerotomy sites had subconjunctival hemorrhage. Three eyes required sutures at 20-gauge sclerotomy sites intraoperatively due to wound leakage. One wound hemorrhage occurred at a 23-guage sclerotomy site. Vitreous hemorrhage (4 eyes), hyphema (2 eyes), and vitreous hemorrhage with hyphema (1 eye) occurred postoperatively. Postoperative hypotony, retinal detachment, and other complications did not occur. CONCLUSIONS: A combination of 23-gauge and 20-gauge transconjunctival sutureless vitrectomy which was created by modifying transconjunctival sutureless vitrectomy systems published previously guarded against sclerotomy wounds and a variety of vitreoretinal surgical indications.

Isolation of porcine multipotential skin-derived precursor cells and its multilineage differentiation

There are increasing reports regarding regeneration of the defected tissues using tissue engineering technique. In this technique, multipotential stem cells are essential. There are many potential sources of adult stem cells, such as bone marrow, umbilical cord blood, fat, muscle, dental tissues and skin. Among them, skin is highly accessible and easily obtained with a minimum of donor site complications. Moreover, skin is an abundant adult stem cell sources and has the potential for self-replication and immune privilege. In this study, we isolated skin-derived precursor cells (SKPs) from the ear of adult miniature pigs. In these SKPs, the expression of transcriptional factors, Oct-4, Sox-2, and Nanog were detected by RT-PCR. In vitro osteogenesis and adipogenesis were observed at 3 weeks after transdifferentiations as assayed by positive von Kossa and Oil-red O staining, respectively. In addition, expression of osteocalcin and osteonectin in the osteogenic differentiation medium and PPAR GAMMA2 and aP2 in the adipogenic differentiation medium were detected by RT-PCR. In vitro neurogenesis of porcine SKPs was observed during 24 and 72 hours after treatment of neurogenic differentiation medium. The results of this study suggest that SKPs demonstrate the properties of pluripotence or multipotence and multi-lineage differentiation. This indicates that autogenous SKPs are a reliable and useful source of adult stem cells for regenerative medicine.

Mesenchymal chondrosarcoma on the mandibular body: a case report

Mesenchymal chondrosarcoma is a rare malignant tumor of bone and soft tissue. This aggressive form of chondrosarcoma represents only 3% to 9% of all chondrosarcomas. This neoplasm is characterized by sheets or clusters of undifferentiated spindle or round cells surrounding discrete nodules of well-differentiated cartilage. We experienced a case of mesenchymal chondrosarcoma on mandibular body. Two years ago, the patient had been treated the intrabony cystic lesion on mandiblular left body. At that time, cartilage portion was not detected in the cystic specimen. Two years after cyst enucleation, the recurred large neoplasm in the mandibular left body was noted, and it was diagnosed as 4.5 cm sized mesenchymal chondrosarcoma. The mandibular tumor was widely resected and rigid-plate and cervical musculocutaneous flap were used for reconstruction of resected bone and soft tissues. No complications and recurrence were noted for 6 months postoperatively.

A Case of Macular Edema after Rosiglitazone Use

PURPOSE: To report a case of macular edema after the use of the oral hypoglycemic agent rosiglitazone. METHODS: A 43-year-old man, who had diabetic mellitus and was on oral rosiglitazone therapy, complained of a visual disturbance in his left eye. After fundus examination and optical coherence tomography, macular edema was observed, therefore rosiglitazone therapy was discontinued. RESULTS: After 2 weeks, his visual acuity improved, and macular edema decreased in the left eye on optical coherence tomography. CONCLUSIONS: Rosiglitazone use should be considered as one of the potential causes of macular edema.

The Efficacy of Intravitreal Triamcinolone Acetonide Injection for Macular Edema in Central Retinal Vein Occlusion

PURPOSE: To investigate the effect of intravitreal injection of triamcinolone acetonide (IVTA) for the treatment of macular edema in central retinal vein occlusion (CRVO). METHODS: Seventy patients with CRVO and persistent macular edema were included in this retrospective study. Thirty-six eyes of 36 patients received an intravitreal injection of 4 mg (0.1 cc) triamcinolone and 34 eyes of 34 control patients didnot receive an injection. Any differences in visual acuity and foveal thickness were measured and compared between the two groups. The correlation between the change in foveal thickness and visual acuity was also evaluated. RESULTS: In ischemic CRVO group, the mean difference of visual acuity between the injection and the control groups was not statistically significant (p<0.05) at the initial measurement and at one week, one, three, and six months after the injection. However, in the non-ischemic CRVO group it was not clinically significant (p<0.05) at the initial time, one week or six months after the injection. But it was clinically significant at one months and three months after receiving the injection (p=0.004 and 0.001). The mean difference in foveal thickness was clinically significant (p<0.001). The visual acuity and foveal thickness were correlated in non-ischemic group but not in the ischemic group. CONCLUSIONS: The IVTA appears to be an effective treatment in patients with macular edema associated with CRVO. The visual acuity of patients with non-ischemic CRVO improved temporally after the IVTA injection, but there was no significant improvement in ischemic CRVO group.

The Efficacy of Intravitreal Triamcinolone Acetonide Injection for Macular Edema in Central Retinal Vein Occlusion

PURPOSE: To investigate the effect of intravitreal injection of triamcinolone acetonide (IVTA) for the treatment of macular edema in central retinal vein occlusion (CRVO). METHODS: Seventy patients with CRVO and persistent macular edema were included in this retrospective study. Thirty-six eyes of 36 patients received an intravitreal injection of 4 mg (0.1 cc) triamcinolone and 34 eyes of 34 control patients didnot receive an injection. Any differences in visual acuity and foveal thickness were measured and compared between the two groups. The correlation between the change in foveal thickness and visual acuity was also evaluated. RESULTS: In ischemic CRVO group, the mean difference of visual acuity between the injection and the control groups was not statistically significant (p<0.05) at the initial measurement and at one week, one, three, and six months after the injection. However, in the non-ischemic CRVO group it was not clinically significant (p<0.05) at the initial time, one week or six months after the injection. But it was clinically significant at one months and three months after receiving the injection (p=0.004 and 0.001). The mean difference in foveal thickness was clinically significant (p<0.001). The visual acuity and foveal thickness were correlated in non-ischemic group but not in the ischemic group. CONCLUSIONS: The IVTA appears to be an effective treatment in patients with macular edema associated with CRVO. The visual acuity of patients with non-ischemic CRVO improved temporally after the IVTA injection, but there was no significant improvement in ischemic CRVO group.

Comparison of Autorefraction and Clinical Refraction with or without in Children

PURPOSE: The difference in the values between autorefraction and clinical refraction with or without cycloplegia in children were analyzed as a function of age. METHODS: One hundred and twenty five children (230 eyes) with myopia or hyperopia were classified into three age groups. Their ages ranged from 2 to 14. They were examined with a Cannon RK-5 autorefractor, and experienced personnel the clinical refraction before and after cycloplegia. Discrepancies beyond 0.5 diopter in spherical equivalent, spherical and cylinder power were regarded as being significant and the discrepancy rates (%) were calculated. The mean absolute differences in the values of each refractive component in myopia and hyperopia were also compared separately according to. RESULTS: All the differences by cycloplegia were significantly smaller in the myopia patients over 5 years old. However, only the discrepancy rates of the spherical equivalent and the sphere component between the clinical manifest refraction and the cycloplegic refraction were significantly smaller in the higher age groups. The comparisons between the clinical and autorefraction revealed significant difference between the age groups only in those with myopia with cycloplegia. CONCLUSIONS: There were differences between the cycloplegic refraction and non-cycloplegic refraction values particularly in myopia patients under five years old and in all hyperopic patients. Autorefraction showed differences from the clinical refraction in both myopia and hyperopia regardless of their ages particularly in those without cycloplegia. Therefore, autorefraction and clinical refraction should be used with caution in children.

Ahmed Valve Implantation Using Scleral Tunneling

PURPOSE: To assess the usefulness of Ahmed valve implantation using scleral tunneling. METHODS: Thirty-four eyes of 34 patients with refractory glaucoma who had not responded to medical treatment nor previous glaucoma surgery was given Ahmed valve implantation using scleral tunneling and were enrolled in the study with a minimum follow-up of six months. RESULTS: The mean follow-up period was 7.7 +/- 2.8 months (6~24 months). The mean preoperative IOP was 47.6 +/- 6.9 (25~70) mmHg and the mean postoperative IOP at six months was 18.7 +/- 9.8 (4~31) mmHg. The postoperative success rate was 73.5% and 73.3% at six and eighteen months, respectively, and was not affected by sex, preoperative diagnosis, or preoperative IOP. The postoperative complications were hyphema (4 eyes), choroidal detachment (3 eyes), and immediate hypotony (3 eyes). CONCLUSIONS: Ahmed valve implantation using scleral tunneling is useful, especially when patch graft is not available. The success rate was comparable with other traditional methods such as patch graft and scleral flap.

A Case of Ross' Syndrome with Horner's Syndrome

Ross syndreome is a rare peripheral nervous system disorder defined by Adie' tonic pupil, hyporeflexia, and segmental anhidrosis. The pathogenesis is believed to result from damage to the ganglion cells or postganglionic fibers, including sympathetic, parasympathetic and dorsal root ganglion cells. A 46 year-old woman complained of right ptosis and decreased sweating of right face. The pupil showed anisocoria, which was evaluated under the variable conditions and recorded with the pupillography using Infrared Scanning Laser Photography(HRA , Heidelberg engineering, Germany). The neurologic examinations including starch-iodine test demonstrated areflexia of lower limbs and hypohidrosis of right face. The above examinations provided evidences that the sympathetic and parasympathetic ganglion cells or the post ganglionic fibers were involved and the diagnosis of Ross syndrome with Horner syndrome was made.