Narrowing of the retinal vessels in chronic glaucoma has been recognized only recently. We performed this study to evaluate the vessel diameter in normal and glaucoma eyes, addressing whether the retinal vessel diameters differ with the degree of glaucomatous optic nerve damage. The diameters of the superior temporal and inferior temporal retinal artery and vein were measured at the optic disc border from optic disc photographs of 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects. The photographic magnification was corrected according to Littmanns method. Only one eye per patient and subject was taken for statistical analysis. According to the neuroretinal rim/disc area ratio, the glaucoma group was divided into four stages(early; more than 0.61, medium; 0.60~0.41, advanced; 0.40~0.21, far advanced; less than 0.20). In the normal group the diameter of the inferior temporal vein(0.130+/-0.020mm) was the largest, followed by the superior temporal vein(0.117+/-0.017mm), the inferior temporal artery(0.102+/-0.016mm), finally the superior temporal artery(0.093+/-0.012mm). The retinal vessel diameter decreased significantly with decreasing of the neuroretinal rim/disc area ratio. In the glaucomatous eyes as compared to the normal eyes, the diameters of the inferior temporal and superior temporal retinal artery were significantly smaller at the early and medium stages(p<0.03, p<0.02, respectively). Whereas both inferior temporal and superior temporal retinal vein diameters were significantly samller at the far advanced stage(p=0.01, p=0.005, respectively). The results indicate that generalized reduction of the retinal vessel diameter throughout the retina is related to the severity of glaucoma. From a diagnostic point of view, evaluation of artery diameter rather than vein diameter may be helpful for the differentiation between normal and glaucomatous eyes.
Arteries ; Glaucoma* ; Glaucoma, Open-Angle ; Humans ; Optic Nerve ; Retina ; Retinal Artery ; Retinal Vein ; Retinal Vessels* ; Retinaldehyde* ; Veins

To confirm the value of the peripapillary atrophy(PPA) for the diagnosis and follow-up of patients with glaucoma, we performed magnification-corrected morphometry of photographs of 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects. For the data analysis, only one eye of each patient was randomly selected. Both groups did not differ significantly in age. refractive error and disc area. According to the neuroretinal rim/disc area ratio, the glaucoma group was divided into four stages(1; more than 0.61, 2; 0.60~0.41, 3; 0.40~0.21, 4; less than 0.20). PPA differentiated into two different zones(alpha and beta). Zone alpha(0.76+/-0.55mm2 vs 0.47+/-0.32mm2) and zone beta(0.50+/-0.63mm2 vs 0.06+/-0.15mm2) and the total PPA(1.26+/-0.97mm2 vs 0.54+/-0.38mm2) were significantly larger(p=0.0001), and zone beta occurred more often(59.5% vs 17.4%, P=0.0001) in the glaucoma group than in the normal group. The area, angular extent and width of both zones enlarged significantly with increasing stage of glaucoma. The frequency of zone beta increased with advancing stage of glaucoma. These findings suggest that both zone alpha and beta increase continuously with advancing neural rim damage. Therefore, the PPA is useful for the diagnosis and progression of glaucomatous nerve damage.
Atrophy* ; Diagnosis ; Follow-Up Studies ; Glaucoma ; Glaucoma, Open-Angle* ; Humans ; Refractive Errors ; Statistics as Topic

To evaluate MR findings of soft tissue masses in extremities and to find the helpful findings of distinguish benignity from malignancy, 28 soft tissue masses (22 benign and 6 malignant) in extremities were reviewed. T1-weighted, proton density, T2-weighted and Gd-DTPA enhanced images were obtained. MR images allowed a specific diagnosis in a large number of benign masses, such as hemangioma(8/9), lipoma(2/2), angiolipoma(1/1), epidermoid cyst(2/2), myositis ossificans(1/1), synovial chondromatosis(1/1) and pigmented villonodular synovitis (1/2). Specific diagnosis was difficult in the rest of the masses including malignancy. However, inhomogenous signal intensities with necrosis and inhomogenous enhancement may suggest malignant masses.
Diagnosis ; Extremities ; Gadolinium DTPA ; Myositis ; Necrosis ; Protons ; Synovitis, Pigmented Villonodular

OBJECTIVES: Endoscopic Ultrasonography (EUS) is widely used to diagnose upper gastrointestinal tract disease. In recent, it is reported that EUS is also goood diagnostic method to assess depth of invasion through rectal wall and lymph node involvement of rectal cancer. We performed EUS in preoperative rectal cancer patients and compared to post operative histologic findings to evaluate EUS diagnostic accuracy for rectal cancer staging system METHODS: 51 patients with rectal cancer were performed with EUS. They were diagnosed by endoscopic biopsy from August 1994 to June 1996 at Kangbuk Samsung Hospital. Their ages were 28 to 78 (mean: 55 years) and the male to female ratio was 2 : 1 (34/17). Olympus GF-UM3, EU-M3 EUS and 7.5/12 MHz transducer were utilized. EUS was performed by the deaerated water filling method. We have analyzed between preoperative EUS findings and postoperative biopsy findings in order to evaluate the accuracy of EUS. The accuracy of EUS was signified by percentage. RESULTS: 1) Endoscopic ultrasonographic accuracy for assessment of wall invasion of rectal cancer was as follows ; The accuracy of mucosal cancer was 50% (patient numbers of EUS diagnosis/patient numbers of histologic diagnosis: 2/4). Submucosal cancer was 100% (1/1). Muscularis propria cancer was 44% (4/9). The accuracy with penetration to subserosa (or perirectal fat tissue) was 97% (33/34). The accuracy with invasion to adjacent organ was 33% (1/3). The overall accuracy rate was 80% (41/51). 2) EUS accuracy of lymph node metastasis in rectal cancer was ; The sensitivity was 90% (patient numbers of EUS diagnosis/patient numbers of histologic diagnosis: 28/31). The specificity was 60% (12/20). 3) EUS diagnosis of modified Duke classification was ; The accuracy of A stage was 80% (patient numbers of EUS diagnosis/patient numbers of histologic dagnosis: 4/5). B1 stage was 60% (4/8). B2 stage was 33% (1/3). C1 stage was 0% (0/3). C2 stage was 86%(25/28). D stage was 33% (1/3). The overall accuracy rate was 69% (35/51). CONCLUSION: EUS is useful method to assess rectal cancer invasion through rectal wall and lymph node involvement. However, further refinements in instruments and the techniques is required for more improving diagnostic accuracy.
Biopsy ; Classification ; Diagnosis* ; Endosonography* ; Female ; Humans ; Lymph Nodes* ; Male ; Neoplasm Metastasis* ; Rectal Neoplasms* ; Sensitivity and Specificity ; Transducers ; Upper Gastrointestinal Tract ; Water

BACKGROUND/AIMS: The extraction of large common bile duct (CBD) stones after an endoscopic sphincterotomy (EST) is successful in 80~90% of cases but it often requires a prolonged time and repeated trials. This study investigated the utility of a combined endoscopic papillary large balloon dilatation (EPLBD) and a mid-incision of an EST (m-EST) method for the removal of large CBD stones. METHODS: Thirty patients with large CBD stones were enrolled in this study. EPLBD was carried out using the one-step inflation of a 15~18 mm diameter balloon after m-EST. RESULTS: The maximum stone diameter was 21.62+/-5.38 mm. Twelve patients had more than 4 stones, 7 patients had 2 stones, and the remainder had a single large stone. Complete ductal clearance was achieved in all patients. After the procedure, the serum amylase and/or lipase levels were elevated in 3 patients (13.3%). However, there was no episode of true pancreatitis. Minor bleeding was encountered in only one patient (3.3%), and was easily controlled by an endoscopic epinephrine injection. The procedure was carried out safely in 6 patients with periampullary diverticulum. No perforation or mortality was encountered. CONCLUSIONS: Combined EPLBD and m-EST is a safe and effective method, and may be a good alternative treatment for removing large CBD stones.
Amylases ; Bile Ducts* ; Bile* ; Choledocholithiasis ; Common Bile Duct ; Dilatation* ; Diverticulum ; Epinephrine ; Hemorrhage ; Humans ; Inflation, Economic ; Lipase ; Mortality ; Pancreatitis ; Sphincterotomy, Endoscopic*

The guidelines for chronic obstructive pulmonary disease (COPD) treatment are important for the management of the disease. However, studies regarding the treatment adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have been scarce in Korea. Therefore, to examine the adherence to the GOLD guidelines, we examined the patterns of prescribed medication in COPD patients from 2011 to 2018. Patients were classified as having been appropriately and inappropriately treated (overtreatment or undertreatment) for the GOLD group. Appropriate medical therapy was defined as using the first choice or alternative choice drug recommended in the GOLD guidelines. Inappropriate therapy was classified as overtreatment or undertreatment in accordance with the categorization in the GOLD guidelines. According to treatment of 2011 GOLD guidelines, there was inappropriate treatment in 52.3% in group A, 47.3% in group B, 56.3% in group C, and 17.8% in group D. According to treatment of 2017 GOLD guidelines, there was inappropriate treatment in 66.7% in group A, 45.3% in group B, 14.3% in group C, and 24.0% in group D. The common type of inappropriate COPD treatment is overtreatment, with inhaled corticosteroid (ICS) containing regimens. In conclusions, adherence to the GOLD guideline by the pulmonologist in clinical practice is still low in Korea. Therefore, we need better strategies to both optimize the use of the guidelines and adhere to the guidelines as well.
Humans ; Korea* ; Lung Diseases ; Medical Overuse ; Pulmonary Disease, Chronic Obstructive*

PURPOSE: The purpose of this study was to investigate the effect of hospital case volume on clinical outcomes in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: Data on 1,073 patients with cT1-4N0-3M0 NPC were collected from a multi-institutional retrospective database (KROG 11-06). All patients received definitive radiotherapy (RT) either with three-dimensional-conformal RT (3D-CRT) (n=576) or intensity-modulated RT (IMRT) (n=497). The patients were divided into two groups treated at high volume institution (HVI) (n=750) and low volume institution (LVI) (n=323), defined as patient volume ≥ 10 (median, 13; range, 10 to 18) and < 10 patients per year (median, 3; range, 2 to 6), respectively. Endpoints were overall survival (OS) and loco-regional progression-free survival (LRPFS). RESULTS: At a median follow-up of 56.7 months, the outcomes were significantly better in those treated at HVI than at LVI. For the 614 patients of propensity score-matched cohort, 5-year OS and LRPFS were consistently higher in the HVI group than in the LVI group (OS: 78.4% vs. 62.7%, p < 0.001; LRPFS: 86.2% vs. 65.8%, p < 0.001, respectively). According to RT modality, significant difference in 5-year OS was observed in patients receiving 3D-CRT (78.7% for HVI vs. 58.9% for LVI, p < 0.001) and not in those receiving IMRT (77.3% for HVI vs. 75.5% for LVI, p=0.170). CONCLUSION: A significant relationship was observed between HVI and LVI for the clinical outcomes of patients with NPC. However, the difference in outcome becomes insignificant in the IMRT era, probably due to the standardization of practice by education.
Cohort Studies ; Disease-Free Survival ; Education ; Follow-Up Studies ; Humans ; Nasopharyngeal Neoplasms ; Radiotherapy ; Radiotherapy, Intensity-Modulated ; Retrospective Studies* ; Treatment Outcome

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world and is the only major disease that is continuing to increase in both prevalence and mortality. The second Korean National Health and Nutrition Survey revealed that the prevalence of COPD in Korean subjects aged > or =45 years was 17.2% in 2001. Further surveys on the prevalence of COPD were not available until 2007. Here, we report the prevalence of spirometrically detected COPD in Korea, using data from the fourth Korean National Health and Nutrition Survey (KNHANES IV) which was conducted in 2007~2009. METHODS: Based on the Korean Statistical Office census that used nationwide stratified random sampling, 10,523 subjects aged > or =40 years underwent spirometry. Place of residence, levels of education, income, and smoking status, as well as other results from a COPD survey questionnaire were also assessed. RESULTS: The prevalence of COPD (defined as forced expiratory volume in 1 sec/forced vital capacity <0.7 in subjects aged > or =40 years) was 12.9% (men, 18.7%; women, 7.5%). In total, 96.5% of patients with COPD had mild-to-moderate disease; only 2.5% had been diagnosed by physicians, and only 1.7% had been treated. The independent risk factors for COPD were smoking, advanced age, and male gender. CONCLUSION: The prevalence of COPD was 12.9% in the KNHANES IV data. Most patients with COPD were undiagnosed and untreated. Based on these results, a strategy for early COPD intervention is warranted in high risk subjects.
Aged ; Censuses ; Female ; Forced Expiratory Volume ; Humans ; Hypogonadism ; Korea ; Male ; Mitochondrial Diseases ; Nutrition Surveys ; Ophthalmoplegia ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; Surveys and Questionnaires ; Risk Factors ; Smoke ; Smoking ; Spirometry ; Vital Capacity