This study involved a cost-utility analysis of early diagnosis and treatment of diabetic retinopathy depending on the screening strategy used. The four screening strategies evaluated were no screening, opportunistic examination, systematic fundus photography, and systematic examination by an ophthalmologists. Each strategy was evaluated in 10,000 adults aged 40 yr with newly diagnosed diabetes mellitus (hypothetical cohort). The cost of each strategy was estimated in the perspective of both payer and health care system. The utility was estimated using quality-adjusted life years (QALY). Incremental Cost Effectiveness Ratio (ICER) for the different screening strategies was analyzed. After exclusion of the weakly dominating opportunistic strategy, the ICER of systematic photography was 57,716,867 and that of systematic examination by ophthalmologists was 419,989,046 from the perspective of the healthcare system. According to the results, the systematic strategy is preferable to the opportunistic strategy from the perspective of both a payer and a healthcare system. Although systematic examination by ophthalmologists may have higher utility than systematic photography, it is associated with higher cost. The systematic photography is the best strategy in terms of cost-utility. However systematic examination by ophthalmologists can also be a suitable policy alternative, if the incremental cost is socially acceptable.
Adult ; Aged ; Aged, 80 and over ; *Cost-Benefit Analysis ; Diabetic Retinopathy/*diagnosis/economics/*therapy ; Diagnostic Techniques, Ophthalmological/economics ; Early Diagnosis ; Female ; Fluorescein Angiography/economics ; Health Care Costs ; Humans ; Male ; Markov Chains ; Mass Screening/*economics/methods/statistics & numerical data ; Middle Aged ; Models, Economic ; National Health Programs/economics ; Quality-Adjusted Life Years ; Republic of Korea

PURPOSE: We examined changes in the corneal curvature and recurrence rate following pterygium surgery with relation to pterygium size and morphology. METHODS: One hundred eyes with primary nasal pterygia were graded as atrophic(Group 1), intermediate (Group 2), or fleshy(Group 3) according to morphology and grouped as small area group or large area group according to an assessment of pterygium length from and along the limbus. Corneal curvature was measured with autokeratometer at 3 days, 1 week, 1 month, and 6months preoperatively and postopera-tively as well. Recurrence was evaluated at the same periods. RESULTS: Each group had no significant difference(p>0.05) to preoperative corneal curvature when pterygia were divided according to morphology. Large area group had significantly smaller corneal curvature than the preoperative one(p<0.05), but small area group didn't(p>0.05). The angle of astigmatism had the tendency of against-the-rule at 3 days postoperatively(163.3degrees), more strikingly in small area group(159.1degrees). The recurrence rate was 10% totally with no significant difference among each group(p>0.05). CONCLUSIONS: The magnitude of the corneal curvature following pterygium surgery was smaller than the preoperative one and the change of angle had the tendency of against-the-rule astigmatism. Surgically induced changes in the corneal curvature and recurrence rate related to morphology had no significant difference, but preoperative corneal curvature and postoperative changes were related to pterygium size.
Astigmatism ; Pterygium* ; Recurrence*

To investigate the relationship between psychological behavior and the development of central serous chorioretinopathy, we performed a study on stress and personality characteristics on 39 central serous chorioretinopathy patients and 38 healthy subjects as a control group. We used Life Change Inventory(MMPI) for personality characteristics. As a result, the mean stress scale in the patients group was significantly higher than in the normal control group(p<0.05) and the mean T-xcore of three neurotic scales such as hypochondriasis, depression and hysteria in the patients group were significantly higher than in the normal control group(p=0.029, 0.004, 0.012).
Central Serous Chorioretinopathy* ; Climacteric ; Depression ; Humans ; Hypochondriasis ; Hysteria ; MMPI ; Weights and Measures

Assessment of the optic nerve head or the retinal nerve fiber layer is essential for the early diagnosis and monitoring of glaucoma. We compared mean retinal nerve fiber layer[RNFL]thickness with Average, and compared RNFL CSA with Integral between Heidelberg Retina Tomograph[HRT] and GDx nerve fiber analyzer[GDx]at global, superior, inferior, nasal and temporal area. Mean RNFL thickness in HRT was significantly greater than Average in GDx at all quadrants[p<0.001], and correlated with Average at global, superior and inferior area[p<0.05]. RNFL CSA in HRT was significantly greater than Integral in GDx at superior, inferior and nasal quadrants[p<0.001], and correlated with Integral at superior and inferior quadrants[p<0.05]. In conclusion, the two parameters related to nerve fiber layer in HRT were measured greater than those in GDx. Correlations of the above parameters between HRT and GDx were mainly present at superior and inferior quadrant. These results may come from regional difference in measurement between HRT and GDx, and uncorrected disc tilting in HRT appears to have adverse effects on the correlations of the above parameters between HRT and GDx at nasal or temporal quadrant.
Early Diagnosis ; Glaucoma ; Nerve Fibers* ; Ophthalmoscopes* ; Optic Disk ; Retina ; Retinaldehyde*

PURPOSE: This study was performed to investigate the growth pattern of the retinal vessel including retinal vascular endothelial cell and pericyte. METHODS: The sensory retina was detached from the eyecup obtained from donor's eye. The retinal vessel which was separated from the sensory retina was cultured in tissue culture media for 2, 3 and 4 weeks separately and examined by transmission electron microscopy. RESULTS: On the second week of tissue culture, both the retinal vascular endothelial cells and pericyte were intact in morphology in nuclear and cytoplasmic pattern. Both cells were partially detached from the surrounding basement membrane. On the third week of tissue culture, the cytoplasm of the retinal vascular endothelial cells and pericyte were degenerated, whereas the vascular endothelial cell were intact in nuclear and cytoplasmic profiles which were still partially surrounded by the basement membrane. CONCLUSIONS: These findings suggest that the survivability of the retinal vascular endothelial cells and pericyte may be limited for 2 and 3 weeks, separatedly under the ordinary culture medium.
Basement Membrane ; Culture Media ; Cytoplasm ; Endothelial Cells ; Microscopy, Electron, Transmission ; Pericytes ; Retina ; Retinal Vessels* ; Retinaldehyde*

Migration of roundworms, Ascaris lumbricoies, into the biliary tract is a relatively common cause of biliary symptoms in endemic areas, but the number of reported gallbladder ascariasis was scanty even in these areas. Some diagnostic methods might provide suggestive informations, but there are no pathognomonic clinical features for biliary ascariasis, so it is discovered usually after surgical exploration, which is especially the case of gallbladder ascariasis. A young female patient with 4 months' history of right upper quadrant pain which did not respond to medical control and was aggravated recently, presented normal level of peripheral blood leukocyte count with no eosinophilia, normal liver function test, normal serum amylase level and subjectively no febrile sense. Abdominal ultrasonogram disclosed a long, thick, linear, non-motile echogenic structure, not accompanied by acoustic shadowing, within the gallbladder. The intra-and extra-hepatic bile ducts were not dilated and the pancreas was revealed as normal echogenecity and contoru. Endoscopic retrograde cholangiopancreatography was performed immediately thereafter, and it showed a thin linear filling defect in the gallbladder. Cholecystectomy was performed under the impression of gallbladder ascariasis. A mummified Ascaris lumbricoides was found in the lumen of the gallbladder. There was no stones and the histologic examination of the gallbladder revealed chronic cholecystitis.
Acoustics ; Amylases ; Ascariasis* ; Ascaris ; Ascaris lumbricoides ; Bile Ducts ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystitis ; Eosinophilia ; Female ; Gallbladder* ; Humans ; Leukocyte Count ; Liver Function Tests ; Pancreas ; Shadowing (Histology) ; Ultrasonography

Migration of roundworms, Ascaris lumbricoies, into the biliary tract is a relatively common cause of biliary symptoms in endemic areas, but the number of reported gallbladder ascariasis was scanty even in these areas. Some diagnostic methods might provide suggestive informations, but there are no pathognomonic clinical features for biliary ascariasis, so it is discovered usually after surgical exploration, which is especially the case of gallbladder ascariasis. A young female patient with 4 months' history of right upper quadrant pain which did not respond to medical control and was aggravated recently, presented normal level of peripheral blood leukocyte count with no eosinophilia, normal liver function test, normal serum amylase level and subjectively no febrile sense. Abdominal ultrasonogram disclosed a long, thick, linear, non-motile echogenic structure, not accompanied by acoustic shadowing, within the gallbladder. The intra-and extra-hepatic bile ducts were not dilated and the pancreas was revealed as normal echogenecity and contoru. Endoscopic retrograde cholangiopancreatography was performed immediately thereafter, and it showed a thin linear filling defect in the gallbladder. Cholecystectomy was performed under the impression of gallbladder ascariasis. A mummified Ascaris lumbricoides was found in the lumen of the gallbladder. There was no stones and the histologic examination of the gallbladder revealed chronic cholecystitis.
Acoustics ; Amylases ; Ascariasis* ; Ascaris ; Ascaris lumbricoides ; Bile Ducts ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystitis ; Eosinophilia ; Female ; Gallbladder* ; Humans ; Leukocyte Count ; Liver Function Tests ; Pancreas ; Shadowing (Histology) ; Ultrasonography

Hemodialysis that to maintain life quality and may be preliminary stage of kidney transplantation is essential in end-stage renal disease(Esrd) patients. Since 1996, Brescia-cimino are used to internal radio- cephalic fistula and this fistula method was the most popular in world-wide. And then variable methods (e.g, Autogenous, PTFE, Dacron etc.) were usually tried instead of above standard fistula. We experienced 75 fistulas in 62 cases from Jan. 1993 to Dec. 1996 and among 75 fistula operations standard radio-cephalic fistula was 56, brachio-cephalic fistula 10, graft fistula 9. Early patency failure rate of A-V fistula was 9 cases, 14.5%. Significant factors to effect in patency of A-V fistula were propably diabetic mellitus, venous diameter, graft material and were not related to age/sex, blood pressure, BUN/creatinine etc. In conclusion the reduction of early patency failure rate in A-V fistula is to maintain long patency rate of A-V fistula
Blood Pressure ; Fistula ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation ; Polyethylene Terephthalates ; Polytetrafluoroethylene ; Quality of Life ; Renal Dialysis ; Transplants

No abstract available.
Ultrasonography*

PURPOSE: This study was designed to evaluate the clinical charateristics, surgical treatment and outcome of carcinoid tumors of the rectum. METHODS: A retrospective review of the charts of all patients treated for rectal carcinoid tumors at Kangbuk Samsung Medical Center between Jan 1989 and April 1998. Thirteen patients with rectal carcinoids tumors were treated. Follow-up data, histopathological information and surgical procedures were obtained from case notes. RESULTS: There were 10 men and 3 women. The ages ranged from 28 to 60 years (mean 41.1 years for all, 43.8 years for men and 32 years for women). Eight patients (61.5%) had no symptoms. Of the five patients, four complained of rectal bleeding (30.8%), and one complained of defecational difficulty (7.7%). Size of rectal carcinoid tumor was less than 1 cm in 7 patients (53.8%), between 1 cm and 2 cm in 2 patients (15.4%), in four patients (30.8%) larger than 2 cm. Three patients were treated in Abdominoperineal resection. Two patients underwent stapled low anterior resection. The remaining 8 patients underwent conservative resection (3 colonoscopic polypectomy and electrocauterization, 2 colonoscopic snaring biopsy, 2 transanal resection and one Mason's operation). The depth of invasion was contained within sutmucosa in 3 patients. Liver metastasis was found in 2 patients. Average follow-up time was 35.6 months. Two patients died of mutiple mestastasis (liver, bone, peritoneum) 9 and 30months later. CONCLUSION: We concluded that tumors smaller than 1 cm could be managed by local treatment whereas larger than 2 cm should be managed by radical treatment.
Biopsy ; Carcinoid Tumor* ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver ; Male ; Neoplasm Metastasis ; Rectum ; Retrospective Studies ; SNARE Proteins