OBJECTIVE: We present a clinical analysis to envision the difficulties in supraclinoid internal carotid artery(ICA) aneurysmal neck clippings to improve the postoperative outcome. METHODS: Two hundred and fifty aneurysm surgeries were undertaken at our hospital from 1997 to 1998. There were 52 patients(20.4% of the total) of supraclinoid ICA saccular aneurysmal patients. Eighteen cases(34.6%) were found with diverse difficulties in direct neck clippings. The authors analyzed the causes of surgical difficulties in the clipping on supraclinoid ICA aneurysms, in a clinical perspective. RESULTS: Perfect aneurysmal clippings were performed in 45 patients(86.5%) of the total 52 cases of supraclinoid ICA aneurysms. The clipping and wrapping were needed in five cases(9.6%), trapping in one(1.9%) with one case(1.9%) needed only for wrapping. The causes of difficulties in direct neck clipings were : aneurysm sac involving perforator in six cases(11.5%), too short an ICA proximal to posterior communicating artery for temporary clipping in 5(9.6%), posterior communicating artery aneurysm directed to the ventral side in three(5.8%), dorsal wall aneurysm in one, severe atheromatous ICA in one, a larger sac than in angiographic finding with partial thrombosis in one, severe adhesion of aneurysm to 3rd cranial nerve in one patient. CONCLUSION: For supraclinoid ICA aneurysm surgery, sufficient preoperative plans and careful inspection including angiographic findings to foresee the various difficulties of neck clippings are needed.
Aneurysm* ; Arteries ; Carotid Artery, Internal* ; Cranial Nerves ; Humans ; Intracranial Aneurysm ; Neck ; Thrombosis

Age-related macular degeneration (AMD) is a major cause of central vision loss in developed countries. The incidence of AMD has increased rapidly in Korea. The objective of this article is to introduce the latest knowledge about the pathophysiology, diagnostic tools and therapeutic modalities of AMD. The risk factors for AMD are age, smoking, familial history, genetic factors related to the complement system, diet, and cholesterol levels. Inflammation plays an important role in the pathophysiology of AMD and is associated with the complement system. Genes associated with the complement system affect the pathophysiology, expression, progression and therapeutic response of AMD. The use of antioxidants, zinc, and omega-3 fatty acids inhibits progression from moderate AMD to advanced AMD. Although there is no established treatment for dry AMD, treatment with agents that inhibit the complement system or through other mechanisms is under study. A number of anti-vascular endothelial growth factor agents have been developed for the prevention of choroidal neovascularization in the treatment of wet AMD and are being used clinically. Therapeutic alternatives to anti-vascular endothelial growth factor agents are under study.

Age-related macular degeneration (AMD) is a major cause of central vision loss in developed countries. The incidence of AMD has increased rapidly in Korea. The objective of this article is to introduce the latest knowledge about the pathophysiology, diagnostic tools and therapeutic modalities of AMD. The risk factors for AMD are age, smoking, familial history, genetic factors related to the complement system, diet, and cholesterol levels. Inflammation plays an important role in the pathophysiology of AMD and is associated with the complement system. Genes associated with the complement system affect the pathophysiology, expression, progression and therapeutic response of AMD. The use of antioxidants, zinc, and omega-3 fatty acids inhibits progression from moderate AMD to advanced AMD. Although there is no established treatment for dry AMD, treatment with agents that inhibit the complement system or through other mechanisms is under study. A number of anti-vascular endothelial growth factor agents have been developed for the prevention of choroidal neovascularization in the treatment of wet AMD and are being used clinically. Therapeutic alternatives to anti-vascular endothelial growth factor agents are under study.
Antioxidants ; Cholesterol ; Choroidal Neovascularization ; Complement System Proteins ; Developed Countries ; Diet ; Endothelial Growth Factors ; Fatty Acids, Omega-3 ; Incidence ; Inflammation ; Korea ; Macular Degeneration ; Risk Factors ; Smoke ; Smoking ; Vascular Endothelial Growth Factor A ; Zinc

Background: More comprehensive healthcare services should be provided to patients with complex chronic diseases to better manage their complex care needs. This study examined the effectiveness of comprehensive primary care in patients with complex chronic diseases. Methods: We obtained 2002–2019 data from the National Health Insurance Sample Cohort Database. Participants were individuals aged ≥ 30 years with at least two of the following diseases: hypertension, diabetes mellitus, and hyperlipidemia. Doctors’ offices were classified into specialized, functional, and gray-zone based on patient composition and major diagnostic categories. The Cox proportional hazard model was used to examine the association between office type and hospital admission due to all-causes, severe cardiovascular or cerebrovascular diseases (CVDs), hypertension, diabetes mellitus, or hyperlipidemia. Results: The mean patient age was 60.3 years; 55.8% were females. Among the 24,906 patients, 12.8%, 38.3%, and 49.0% visited specialized, functional, and gray-zone offices, respectively. Patients visiting functional offices had a lower risk of all-cause admission (hazard ratio [HR], 0.935; 95% confidence interval [CI], 0.895–0.976) and CVD-related admission (HR, 0.908; 95% CI, 0.844–0.977) than those visiting specialized offices.However, the admission risks for hypertension, diabetes mellitus, and hyperlipidemia were not significantly different among office types. Conclusion This study provides evidence of the effectiveness of primary care in functional doctors’ offices for patients with complex chronic diseases beyond a single chronic disease and suggests the need for policies to strengthen functional offices providing comprehensive care.

Purpose: To predict the presence of tractional retinal detachment (TRD) in eyes with dense vitreous hemorrhage (VH) and proliferative diabetic retinopathy (PDR) by evaluating the status of posterior vitreous detachment (PVD) in fellow eyes using optical coherence tomography (OCT). Methods: A total of 44 eyes from 22 patients who underwent vitrectomy due to dense VH with PDR were enrolled. Using OCT, the PVD status in the fellow eye was divided into two groups (incomplete and complete PVD). The incomplete PVD group included eyes without PVD and eyes with partial PVD. B-scan ultrasonography was performed on eyes with dense VH to evaluate the presence of TRD. Both OCT and B-scan images were reviewed by four ophthalmologists (two novices and two experienced), and the interobserver agreement was evaluated. Results: There was a difference in the interobserver agreement regarding the presence of TRD in eyes with dense VH evaluated by B scan between novice and experienced ophthalmologists (novice, κ = 0.421 vs. experienced, κ = 0.814), although there was no difference between novice and experienced ophthalmologists in the interobserver agreement regarding the status of PVD in the fellow eye evaluated by OCT (novice, κ = 1.000 vs. experienced, κ = 1.000). All observed TRD during vitrectomy occurred in eyes with incomplete PVD in the fellow eye. Logistic regression analysis revealed a statistically significant relation between TRD and the age of the patient (odds ratio [OR], 0.874; p = 0.047), and between TRD and incomplete PVD in the fellow eye evaluated by OCT (OR, 13.904; p = 0.042). Conclusions Evaluation of the PVD status in the fellow eye using OCT may be a useful predictor for detecting the presence of TRD in eyes with dense VH and PDR.

Hemangioma are not rare tumors. They can be found in almost any of the vascular structures of the body. Hemangiomas involving the deep structures of the extremities may produce extremely difficult therapeutic problems for the orthopedic surgeon. Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder that affects synovium, tendon sheath and bursa. Although the condition can present in any joint, knee joint is the most commonly affected site and only 2.5% of cases occur in foot and ankle joint. We have experienced a patient who has of foot and report an optimal method of surgical treatment. Authors report the result of hemangioma in mid-foot which arise from removal of a pigmented villonodular synovitis that has low out break rate of benign tumor in mid-foot with literature review.
Ankle Joint ; Caves ; Extremities ; Foot ; Hemangioma ; Hemangioma, Cavernous ; Humans ; Joints ; Knee Joint ; Orthopedics ; Synovial Membrane ; Synovitis, Pigmented Villonodular ; Tendons

PURPOSE: We compared ocular torsion rates in blow-out fracture patients before and after blowout fracture repair by analyzing mean disc foveal angles. METHODS: The study participants were divided into 2 groups: blow-out fracutre repair patients (n = 36) and controls (n = 36). We measured ocular torsion rates by analyzing mean disc foveal angle. The angle was composed of 2 imaginary horizontal lines which crossed the optic disc center and fovea. We compared statistically ocular torsion rates in blow-out fracture patients based on subsided diplopia, continued diplopia, or absence of diplopia before and after blow-out fracture repair using paired t-test. RESULTS: In the patient group, ocular torsion rates were statistically significantly decreased. In the blow-out fracture repair group with subsided diplopia, ocular torsion rates were decreased statistically from 7.74 +/- 3.48 degrees before blow-out fracture repair to 5.02 +/- 3.11 degrees after blow-out fracture repair. In the blow-out fracture repair group with continued diplopia or absence of diplopia before surgery, ocular torsion rates did not change statistically significantly from 6.36 +/- 2.80 degrees before blow-out fracture repair to 6.51 +/- 3.24 degrees after blow-out fracture repair. CONCLUSIONS: Subsided diplopia after blow-out fracture repair and ocular torsion rate changes were significantly related in blow-out fracture patients. Further research which on the correlation of intraorbital change and movement of orbital position after blow-out fracture repair with ocular torsion rates are necessary.
Diplopia* ; Humans ; Orbit ; Orbital Fractures*

PURPOSE: To investigate the clinical usefulness of a follow-up examination using serum squamous cell carcinoma antigen (SCC) for the early detection of recurrence in patients treated for cervical squamous cell carcinoma. MATERIALS AND METHODS: 20 patients who were treated for recurrent cervical squamous cell carcinoma between 1997 and 1998, who had experienced a complete remission after radiotherapy and who underwent an SCC test around the time when recurrence was detected, were included in this study. The levels of SCC were measured from the serum of the patients by immunoassay and values less than 2 ng/mL were regarded as normal. The sensitivity of the SCC test for use in the detection of recurrence, the association between the SCC values and the recurrence patterns and the tumor size and stage, and the temporal relation between the SCC increment and recurrence detection were evaluated. RESULTS: The SCC values were above normal in 17 out of 20 patients, so the sensitivity of the SCC test for the detection of recurrence was 85%, and the mean and median of the SCC values were 15.2 and 9.5 ng/mL, respectively. No differences were observed in the SCC values according to the recurrence sites. For 11 patients, the SCC values were measured over a period of 6 months before recurrence was detected, and the mean and median values were 13.6 and 3.6 ng/mL, respectively. The SCC values of 7 patients were higher than the normal range, and the SCC values of the other 4 patients were normal but 3 among them were above 1.5 ng/mL. At the time of diagnosis, the SCC valuess were measured for 16 of the 20 recurrent patients, and the SCC values of the patients with a bulky tumor (> or =4 cm) or who were in stage IIb or III were higher than those of the patients with a non-bulky tumor or who were in stage Ib or IIa. CONCLUSION: The SCC test is thought to be useful for the early detection of recurrence during the follow up period in patients treated for cervical squamous cell carcinoma. When an effective salvage treatment is developed in the future, the benefit of this follow-up SCC test will be increased.
Carcinoma, Squamous Cell* ; Cervix Uteri* ; Diagnosis ; Female ; Follow-Up Studies* ; Humans ; Immunoassay ; Radiotherapy ; Recurrence ; Reference Values ; Uterine Cervical Neoplasms

Purpose: To explore the association between the visual and anatomical outcomes and the choroidal vascularity index (CVI) post-intravitreal injection in patients with macular edema associated with branch retinal vein occlusion (BRVO). Methods: We conducted a retrospective review of medical records of 50 patients (27 eyes treated with anti-vascular endothelial growth factor and 23 eyes treated with a dexamethasone implant) with BRVO and macular edema who underwent intravitreal injections from January 2017 to October 2020. We measured the central macular thickness (CMT), subfoveal choroidal thickness, and CVI of the BRVO eyes and the fellow eyes using optical coherence tomography and then analyzed the correlation between these measurements and visual and anatomical outcomes. Results: After six months of treatment, the best corrected visual acuity improved, and CMT decreased. Multiple linear regression analysis revealed that factors associated with best corrected visual acuity improvement at six months were fellow eye CVI (standardized β = 0.346, p = 0.008), ellipsoid zone integrity (standardized β = 0.398, p = 0.001), and initial best corrected visual acuity (standardized β = 0.590, p < 0.001). Initial CMT (standardized β = 0.563, p < 0.001) was the only factor associated with the decrease in CMT at six months. Conclusions In cases of severe macular edema, accurate evaluation of choroidal vessels can be challenging due to shadowing. We discovered that a larger CVI in the fellow eye was associated with greater visual improvement in patients with BRVO and macular edema. CVI could be a prognostic factor for predicting treatment outcomes in BRVO patients, suggesting that the choroidal vascular status may play a role in the pathophysiology of BRVO.