Clinical Outcomes of Idiopathic Epiretinal Membrane Removal in Patients 80 Years or Older

PURPOSE: To evaluate clinical outcomes of idiopathic epiretinal membrane removal in patients ≥ 80 years of age.METHODS: A retrospective review of medical records was performed with 56 patients who underwent vitrectomy and removal of idiopathic epiretinal membrane. In the ≥ 80 years of age group (n = 28), the best-corrected visual acuity (BCVA) and central macular thickness (CMT) before surgery were compared with those at the final follow-up. The amount of change in the BCVA after surgery was also compared between the ≥ 80 years of age group and the < 80 years of age group (n = 28).RESULTS: In the ≥ 80 years of age group, the mean follow-up period was 19.1 ± 17.0 months. Before surgery, 11 eyes were pseudophakic and 17 eyes were phakic. Combined cataract surgery was performed with epiretinal membrane removal in all 17 phakic eyes. The mean logarithm of the minimal angle of resolution BCVA was 0.75 ± 0.30 before surgery, which improved to 0.50 ± 0.30 at the final follow-up (p < 0.001). The CMT was 458.0 ± 79.7 µm before surgery, which decreased to 367.2 ± 83.4 µm at the final follow-up (p < 0.001). There was no significant difference in the amount of change in the BCVA after the surgery between the ≥ 80 years of age group and the < 80 years of age group (p = 0.547).CONCLUSIONS: In patients with idiopathic epiretinal membrane who were ≥ 80 years of age, the visual acuity was improved or maintained, and was accompanied with anatomical improvement after epiretinal membrane removal with or without cataract surgery. These results suggest the usefulness of epiretinal membrane removal in older patients.

Characteristics of Patients Older than 90 Years Diagnosed with Neovascular Age-related Macular Degeneration

PURPOSE: To evaluate the characteristics of patients aged ≥ 90 years who were diagnosed with neovascular age-related macular degeneration (AMD). METHODS: A retrospective review of medical records was performed for 44 patients aged ≥ 90 years diagnosed with neovascular AMD. History of cerebrovascular or cardiovascular disorder and visual acuity at diagnosis were assessed. Fellow eye visual acuity data were also collected. When the fellow eye visual acuity was worse than 0.5, the primary reason for the visual deterioration was identified. RESULTS: The mean patient age was 91.5 ± 1.5 years (range: 90–95 years). Ten (22.7%) patients had histories of cerebrovascular or cardiovascular disorders. The mean logarithm of the minimal angle of resolution (logMAR) of visual acuity was 1.11 ± 0.51 and the visual acuity was worse than 0.1 in 20 eyes (45.5%). The fellow eye visual acuity was worse than 0.5 in 26 eyes (59.1%). The primary reason was neovascular or atrophic AMD in 23 eyes (88.5%). CONCLUSIONS: The incidence of cerebrovascular or cardiovascular disorders was relatively high in patients aged ≥ 90 years. Patients also had poor visual acuity at diagnosis and a high incidence of fellow eye visual deterioration. These systemic conditions should be considered when treating these patients. Additionally, a regular ophthalmic examination is recommended for the early detection of these disorders.

Fourteen Anti-vascular Endothelial Growth Factor Injections for Age-related Macular Degeneration: Ending Period and Clinical Outcome

PURPOSE: To evaluate the clinical course of patients who had completed 14 ranibizumab or aflibercept monocular treatments. METHODS: Retrospective medical record analysis was performed to 24 patients who were diagnosed with monocular neovascular age-related macular degeneration and had completed 14 ranibizumab or aflibercept monocular injections, allowed by the Korean National Health Care system. Time to completion was measured along with the percentage and timing of medication switch. Best-corrected visual acuity (BCVA) was measured at the time of diagnosis, after 3-loading injections, and the time of completion. Additionally, we searched for any other factors that had influenced the time to completion. RESULTS: The average time to completion of 14 injections was 32.3 ± 6.2 months (21–48 months). The switching was performed in 17 eyes (70.8%), and it was done after 9.4 ± 2.1 injections (4–14 injections) with prior medication. After 14 injections, the BCVA improved in 6 eyes (25.0%), unchanged in 8 eyes (33.3%), and worsened in 10 eyes (41.7%). Complete resolution of intraretinal fluid and subretinal fluid after 3 loading injections were observed in 20 eyes, and it was significantly related to time to the first recurrence and time to the completion of 14 injections (p = 0.007, r = 0.583). CONCLUSIONS: The average time to completion of 14 injections was 32.3 months, and switching of medication was performed in 70.8%. Longer time to the first recurrence was related to longer completion time. This study will provide useful facts when informing the patients their future treatment plans under the Korean Health Care system.

The Effects of Lower Lid Laxity to the Response of Dry Eye Treatments

PURPOSE: To compare the response of dry eye treatment in patients divided by the degree of lower lid laxity. METHODS: Thirty patients were classified into three groups - normal, moderate and severe, according to the degree of lower lid laxity. Tear break-up time (TBUT), Schirmer test (ST), ocular surface disease index (OSDI) scores and changes in OSDI score in each group were compared before and at 3 months after the treatment. RESULTS: TBUT, ST and OSDI scores were not different among the three groups at baseline. TBUT improved to 6.60 +/- 1.43, 6.0 +/- 2.54 and 6.0 +/- 1.45 sec in normal, moderate and severe lower lid laxity group, respectively at 3 months after the treatment and no difference among the groups was found. ST scores did not increase after the treatment, while OSDI scores improved to 12.20 +/- 1.40, 16.10 +/- 4.63 and 20.80 +/- 4.52 in each group, respectively and they were significantly different (p = 0.029, 0.029, <0.001, respectively). The response to the dry eye treatment as assessed by changes in OSDI scores was poorer in patients in the severe lower lid laxity group (p = 0.019 vs. moderate laxity group, <0.01 vs. normal group). CONCLUSIONS: As the degree of lower lid laxity increases, the response to dry eye treatment becomes poorer even when TBUT increases.

The Role Transition and Development Direction of the Psychiatric Day Hospital in General Hospital : Introduction of Day Intensive Care Center / 신경정신의학

The role of the day hospital as a mediator between psychiatric ward admission and return to the community has been weakening in general hospitals. The purpose of this paper is to suggest new developmental directions for the day hospital in general hospitals. The history and the operation model of day hospitals were investigated through a bibliographic search. The national mental health care system and the operational realities of the day hospital were also reviewed. The Seoul National University Hospital (SNUH) Day intensive care center (DICC) was introduced ; we then observed several indexes of the SNUH day hospital before and after the institution of DICC. The number of national community mental health care centers is increasing, and the role of this center is similar to the role of the day hospital. The SNUH day hospital invented a short-term intensive care program named DICC for patients with obsessive compulsive disorder, panic and mood disorders and showed marked increment of the number of patients and income after introduction of the DICC. There might be some benefits in introduction of the DICC to psychiatric day hospitals. The role of the DICC will be highlighted in general hospitals, not only for improvement of day hospital management, but also to help patients through early intervention.

Multidimensional Comparison of Personality Characteristics in Genetic High Risk for Schizophrenia, First Episode Psychosis and Healthy Controls / 대한정신분열병학회지

OBJECTIVES: Previous studies have suggested that some personality characteristics are associated with the onset, prognosis and social function in schizophrenia patients. However few is known about the personality and affective characteristic of genetic high risk group (GHR) for schizophrenia. This study aimed to investigate the personality and the affective characteristic of GHR group for schizophrenia. METHODS: Participants were 54 healthy controls (HC), 26 subjects with GHR for schizophrenia and 28 subjects with first episode psychosis (FEP). We performed three self-report questionnaires; NEO-Personality Inventory-Revised, State and Anger Expression Inventory and Positive Affect and Negative Affect Schedule. RESULTS: The GHR group showed higher score in agreeableness item than the HC (p=0.028). In extraversion item, the FEP group showed significantly lower scores than the HC (p=0.001). The GHR group showed lower scores in neuroticism item compared with FEP group in trend level. The FEP group showed higher trait-anger, lower positive affect and higher negative affect compared with the others. CONCLUSION: The GHR group seem to share certain vulnerable personality and affective characteristics for schizophrenia with the FEP group. On the other hands, the GHR group appeared to be more agreeable than the other groups, which might act as the compensation for other impaired functions.

Fibrovascular polyp of the esophagus in infant

A five month female was referred complaining of intermittent vomiting with protrusion of a sausage-like mass through the oral cavity. Esophageal endoscopy and esophagogram revealed a mass in the upper esophagus, which was diagnosed as a fibrovascular polyp. Under general anesthesia, the mass was grasped through the oral cavity with a forcep and ligated and excised at the base, where a stump arose from the posterior wall of the cervical esophagus. The pathology was confirmed as a fibrovascular polyp, which is a rare benign esophageal lesion occurring mostly in adult males, and has not been reported in infancy.

A Case of Infantile Fibromatosis of Neck / 대한이비인후과학회지

Infantile fibromatosis, which represents the childhood counterpart of musculoaponeurotic fibromatosis (abdominal or extraabdominal desmoid), usually arises as a solitary mass in skeletal muscle or in the adjacent fascia, aponeurosis, or periosteum. It chiefly affects children from birth to 8 years of age and is slightly more common in boys than in girls. Although infantile fibromatosis is a benign tumor, its nature is malignant for an aggressive clinical course with a tendency to recur in high percentage. Complete excision with an ample margin, the choice of treatment, is often extremely difficult and in some cases, may be impossible without disfigurement or dysfuction. In recurred cases, supplemental radiotherapy and chemotherapy can be tried. We present one case of infantile fibromatosis that has appeared at the right neck during first several months of life. The lesion was excised and diagnosis was confirmed by histologic examination. Some reviews with literature were supplemented.

The Changes of Vestibulo-Ocular Reflex after Acute Peripheral Unilateral Vestibular Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: It is well known that compensation begins after acute unilateral peripheral vestibular function loss. The change of vestibulo-ocular reflex (VOR) is variable and affected by many factors. But there is no studies reported on the changes of individuals with the lapse of time. Using the rotation chair test and caloric test, we wanted to know the individual compensatory process of VOR as time progresses following an acute unilateral peripheral vestibular loss. MATERIALS AND METHODS: Subjects were patients of acute peripheral vestibular neuritis (n=19) whose nystagmus showed more than 24 hours. The follow up period was 10 weeks until the head shake nystagmus (HSN) disappeared. We measured the duration of each spontaneous nystagmus (SN) and HSN. Sinusoidal harmonic acceleration (SHA) was tested at 0.04 and at 0.08 Hz level, with the step velocity of 100 degrees per second. We also performed caloric test after HSN disappeared. RESULTS: SN and HSN each lasted 25 days and 50 days. VOR changes had an irregular pattern among individuals with gain increasing after decrement and phase lead decreasing after increment. Furthermore, the gain asymmetry was more irregular and lasted longer as well at the step velocity. Even though compensation has been reached, the caloric test revealed continuous abnormal values, which is quite different from the recovery of VOR in the rotatory test. CONCLUSION: During the early compensation period, we could recognize that the individual VOR changes recovered with a irregular pattern. On the other hand, the caloric test was not altered even after compensation.

The Efficacy of Stellate Ganglion Block in the Treatment of Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A stellate ganglion block (SGB) induces vasodilatation in the head, neck, and upper extremities. Based on this principle, SGB has been widely used as one of the treatment modalities in sudden idiopathic sensorineural hearing loss (S-SNHL). However, until now, published data establishing the statistical significance of the effect of SGB has been slim. We conducted this study to find out the effect of SGB in the treatment of idiopathic S-SNHL and to find out the factors influencing the prognosis of the disease. MATERIALS AND METHODS: We reviewed the records of 221 patients seen in the past eight years between 1990 to 1997 who had an initial diagnosis of idiopathic S-SNHL and was admitted for treatment. One hundred twenty patients were treated with SGB and the other 101 patients were treated without SGB to use as a control group. RESULTS: The therapeutic result of SGB group was better than that of the control group. Especially, statistical difference was found in the following two subgroups; one in which the interval between the onset of disease and the initiation of treatment was from 8 to 28 days, and the other when the initial hearing loss was below 90 dB. CONCLUSION: We suggest that this study could be utilized as a standard of clinical treatment when SGB is performed.

The Clinical Effects of Laser Surgery in Simple Snorers on Polysomnography / 대한이비인후과학회지

OBJECTIVES: We aimed to evaluate the clinical effects of the recently developed laser surgery in patients who were diagnosed by polysomnography as simple snorers. MATERIALS AND METHODS: We operated on 35 patients with apena index of below 5, using CO 2 laser, from June, 1993 through May, 1994 at Yongdong Severance Hospital. For these patients, we carried out before and after assessments of three different kind: first, a follow-up assessment of subjective symptoms, such as snoring, daytime somnolence, nocturnal arousal, and headache; second, a psychodynamic analysis done by a psychiatrist on insomnia and depression: and third, an assessment of subjective atisfaction for 24 weeks following the surgery. RESULTS: Snoring improved in 74.2% of the patients, and daytime somnolence improved in 80.0% of the patients. Nocturnal arousal showed improvement in all the subjects whereas headache showed improvement in 66. 7% of the patients. In the psychodynamic analysis, insomnia as observed in 22.9% of the subjects, showing significant improvemnt. However, depression didn't improve significantly. Subjecive satisfaction of the surgery was noted to be the greatest at the fouth week of the operation but it gradually decreased thereafter. The most common postoperative complication was foreign body sensation (31.4%), which disappeared spontaneously within 3 to 6-months of the operation. CONCLUSION: Laser snoring surgery in simple snorers is found to be an effective method to lessen snoring. However, patients should be informed beforehand that this method of surgery may not fully meet their expectations.

A Clinical Study of Tracheotomy in Pediatrics / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tracheotomy, although an inevitable procedure in some situations, is often avoided in pediatrics for its frequent and serious complications. So, authors studied clinical characteristics of tracheotomy as observed in pediatrics. MATERIALS AND METHODS: 138 children who underwent tracheotomy during the past twenty years since 1977 were investigated. We analyzed distribution of age and gender, annual frequency, causative disorders for tracheotomy and complications. RESULTS: 1) Number of tracheotomy performed tended to be decreased with time: 2) Tracheotomy was performed two times more frequently in males than in females, and most frequently below eight years old: 3) Most frequent causative disease was head injury (27.5%): 4) Most frequent indication of tracheotomy was ventilator support (49.3%): 5) The history of endotracheal intubation before tracheotomy was 86.2%: 6) The complications of the tracheotomy developed in 39.9%, with the most frequent complications being granulation formation (18.1%), followed by tracheal stenosis (17.4%). 7) Frequency of late complication was relatively lower in the shorter intubation period group (22.9%) than in the longer intubation period groups (51.5% and 33.3%): 8) Late complications were lower in the group who had not been supported by a ventilator: 9) Late comlications did not occurre in cases who were decannulated before 1 month. CONCLUSION: We found that factors associated with complications were duration of endotracheal intubation before tracheotomy, history of ventilator care and timing of decannulation.

Experiences of the Treatment of Laryngeal Cancer in Yongdong Severance Hospital / 대한이비인후과학회지

BACKGROUND AND OBJECTS: Laryngeal cancer is a significant disease in the head and neck malignancy in the aspect of incidence. But, an accurate statistical analysis of long term results is insufficient in Korea. To improve the results of treatment in laryngeal cancer, we evaluate the survival rates according to the primary site, stage and investigating factors. MATERIALS AND METHODS: The study group was made up of 132 patients with squamous cell cancer. They had been treated for laryngeal cancer in our hospital for 11 years from 1985 to 1995. The distribution rates of patients were obtained by the discriptive statistical method according to the sex, age, pathology, primary site and stage. Survival rates were obtained by the Kaplan-Meier method according to the primary site and stage. The AJCC (1992) staging system was used. RESULTS: With respect to the primary site, the survival rate for 5 years was 52.8% in supraglottis and 71.6% in glottis. With respect to the stage, the survival rate was 82.4% in the stage I, 60.3% in the stage II, 53.8% in the stage III and 28.6% in the stage IV. The 5-year survival rate for patients who had taken radiotherapy in T1 glottic cancer was 73.5% for the group involved with anterior commissure and 96.2% for the group not involved. In the advanced laryngeal cancer, treatment failure was influenced by nodal and stomal recurrence. CONCLUSION: For those patients with T 1 laryngeal cancer and who recieved radiotherapy, a significant prognostic factor was whether or not the patients were involved with anterior commissure. Another important prognostic factor for the advanced laryngeal cancer patients was the complete neck management after the operation and prophylactic neck dissection.

A Case of Kimura's Disease Arising from Epiglottis / 대한이비인후과학회지

Kimura's disease is a chronic inflammatory disease which commonly affects the head and neck regions in young oriental men. It is a rare disease and is found as tumor-like painless swelling with or without lymphadenopathy. However, it's treatment method is not clearly defined. The purpose of this article is to report a very unusual case which is often mistaken for a malignant tumor. A 15-year old male was seen with diffuse epiglottic swelling and cervical lymphadenopathy. CT and MRI showed diffusely enlarged epiglottis with homogenous ensity and bilateral multiple lymphadenopathy in internal jugular and spinal accessory chains. Biopsy of epiglottic mass was performed under the impression of malignant lymphoma. The histology revealed marked lymphoid follicular hyperplasia and massive interfollicular eosinophilic cell infiltration, which was compatible with Kimura's disease. The mass was partially excised especially in laryngeal surface area because the mass was not separated from epiglottis itself. After surgical removal, oral prednisolone was taken. The epiglottis was nearly returned to its normal figure after subsequent excision and vaporization with CO2 laser and neck nodes enlargements were spontaneously resolved. The etiology of this disease is still unknown. It is essential to differentiate it with malignant tumor through biopsy. When Kimura's disease is confirmed, combination of surgical excision and oral steroid appear to be effective therapeutic modality.