PURPOSE: To compare 2 surgical techniques, endoscopic transnasal reconstruction and transcaruncular reconstruction in isolated medial orbital wall fractures. METHODS: This study included 79 isolated medial orbital wall fracture patients from January 2011 to December 2012 of Department of Ophthalmology, Inha University Hospital. The authors compared computed tomographic scans, diplopia, extraocular muscle (EOM) movements, and Hertel's exophthalmometer exams pre- and post-surgery. Thirty-five patients received endoscopic transnasal reconstruction and 44 received transcaruncular reconstruction. RESULTS: The 2 surgical methods showed no significant differences in primary gaze diplopia (p = 0.50), restriction of EOM movements (p = 0.48), remaining enophthalmos of more than 2 mm (p = 0.99), and improvement in enophthalmos (p = 0.07) when compared 6 months after surgery. Statistically significant differences were observed in peripheral diplopia (p = 0.04) 6 months after surgery. CONCLUSIONS: The 2 surgical methods present similar effectiveness in postoperative primary gaze diplopia, EOM restriction, and enophthalmos. With respect to postoperative peripheral diplopia, endoscopic transnasal reconstruction method showed advantages. The surgical method should be selected by comparing advantages and disadvantages.
Diplopia ; Enophthalmos ; Humans ; Ophthalmology ; Orbit*

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poor-quality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.
Benchmarking ; Hospitals ; Humans ; *National Health Programs ; Quality Improvement/*economics ; Quality of Health Care/economics ; Reimbursement, Incentive/*organization & administration ; Republic of Korea

In order to investigate the efficiency of various laboratory studies of uveitis, we performed a series of studies including complete boold count, immunologic tests and radiolgic examination for 70 patients with uveitis and same number of controls who had visited at St. Mary's Hospital, Catholic University Medical College from October 1992 to May 1993. The series of uveitis consists of 24 patients(34.3%) of anterior uveitis, 20 patients(28.6%) of posterior uneitis and 17 patients(24.3%) of intermediate uveitis. Only 7 cases presented positive results for the specific laboratory studies. Two patients of uveitis were positive for cytomegalovirus IgM, one for toxoplasma IgG and one for VDRL. One patient showed evidence of sacroilitis on sacroiliac joint X-ray. Skin test for Clonorchis sinensis was positive in one patient of uveitis. One case in the control group was positive for toxoplasma IgG. From the above results, we suggest that the selective laboratory studies should be carried out on the basis of the patient's histories and ocular findings for the more specific and etiological diagnosis of uveitis.
Clonorchis sinensis ; Cytomegalovirus ; Diagnosis ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Immunologic Tests ; Sacroiliac Joint ; Skin Tests ; Toxoplasma ; Uveitis* ; Uveitis, Anterior ; Uveitis, Intermediate

PURPOSE: Foreign body aspiration in the tracheobronchial tree is a common medical emergency in children and represents an important cause of morbidity and mortality. This study was aimed to analyze the clinical spectrum of tracheobronchial foreign bodies in children and to evaluate the causes of late diagnoses. METHODS: A total of 108 patients with foreign body aspiration were recruited in the last 10 years, who had a flexible or rigid bronchoscopic examination. The age, sex, symptoms, causes of aspiration, radiologic findings, and clinical courses were investigated retrospectively. Patients were divided into 2 groups according to the elapsed time from aspiration to a definite diagnosis as early (< or =24 hours after aspiration) and late diagnoses (>24 hours after aspiration). The two groups were compared for clinical courses, radiologic findings, and the duration of admission of early- and late-diagnosed foreign body aspiration. RESULTS: Approximately 80% of the patients were less than 24 months of age and the most common symptoms were the sudden onset of a cough. Hyperinflation or obstructive emphysema (52.8%) and normal chest radiographs (19.4%) were the most frequent radiologic findings. Plain chest radiographies revealed visible foreign bodies in 7.4% of all patients with foreign body aspiration. Nuts were the most common foreign bodies aspirated. Sudden onset of a persistent cough and fever were predominant in the late-diagnosed group.(P<0.05) CONCLUSION: Our results suggest that clinical suspicion upon interviewing is enough to indicate bronchoscopy. The best way to reduce the number of accidents and deaths associated with foreign body aspiration is to promote public prevention polices.
Bronchoscopy ; Child ; Cough ; Delayed Diagnosis ; Diagnosis* ; Emergencies ; Emphysema ; Fever ; Foreign Bodies* ; Humans ; Mortality ; Nuts ; Radiography, Thoracic ; Retrospective Studies ; Thorax

PURPOSE: The effect of accelerated aging on color stability of various dual-cured self-adhesive resin cements were evaluated in this study. MATERIALS AND METHODS: Color stability was examined using three different brands of dual-cured self-adhesive resin cements: G-CEM LinkAce (GC America), MaxCem Elite (Kerr), and PermaCem 2.0 (DMG) with the equivalent color shade. Each resin cement was filled with Teflon mold which has 6 mm diameter and 2 mm thickness. Each specimen was light cured for 20 seconds using light emitting diode (LED) light curing unit. In order to evaluate the effect of accelerated aging on color stability, color parameters (Commission Internationale de l'Eclairage, CIE L*, a*, b*) and color differences (DeltaE*) were measured at three times: immediately, after 24 hours, and after thermocycling. The L*, a*, b* values were analyzed using Friedman test and DeltaE* values on the effect of 24 hours and accelerated aging were analyzed using t-test. These values were compared with the limit value of color difference (DeltaE*=3.7) for dental restoration. One-way ANOVA and Scheff's test (P<0.05) were performed to analyze each DeltaE* values between cements at each test period. RESULT: There was statistically signifi cant difference in comparison of color specifi cation (L*, a*, b*) values after accelerated aging except L* value of G-CEM LinkAce (P<0.05). After 24 hours, color difference (DeltaE*) values were ranged from 2.47 to 3.48 and L* values decreased and b* values increased in all types of cement and MaxCem Elite had high color stability (P<0.05). After thermocycling, color change's tendency of cement was varied and color difference (DeltaE*) values were ranged from 0.82 to 2.87 and G-CEM LinkAce had high color stability (P<0.05). CONCLUSION: Color stability of dual-cured self-adhesive resin cements after accelerated aging was evaluated and statistically significant color changes occurred within clinically acceptable range.
Aging* ; Fungi ; Polytetrafluoroethylene ; Resin Cements*

The incidence of colorectal cancer (CRC) is increasing among young adults in several countries including the United States. Early-onset colorectal cancer (EO-CRC) is heterogenous group and appears to have a distinct clinical, pathologic, and molecular presentation compared to CRC diagnosed in older patients. EO-CRC patients tend to be diagnosed at later stage and with symptomatic disease. Tumors arise predominantly in the distal colon and rectum and have poorer histological features. Microsatellite and chromosome stable molecular pathway is frequently observed in EO-CRC. Survival data of EO-CRC is conflicting and younger patients tend to be treated more aggressively. It is important to identify high risk and have them screened appropriately to address increasing EO-CRC. Screening and treatment strategies for EO-CRC should be developed through further investigation of molecular mechanism and various environmental risk factors. In Korea, EO-CRC and late-onset CRC have both declined in recent several years, probably due to many screening colonoscopies in young population. Close observation and analysis of EO-CRC in Korea is necessary.
Colon ; Colonoscopy ; Colorectal Neoplasms ; Humans ; Incidence ; Korea ; Mass Screening ; Microsatellite Repeats ; Rectum ; Risk Factors ; United States ; Young Adult

The incidence of colorectal cancer (CRC) is increasing among young adults in several countries including the United States. Early-onset colorectal cancer (EO-CRC) is heterogenous group and appears to have a distinct clinical, pathologic, and molecular presentation compared to CRC diagnosed in older patients. EO-CRC patients tend to be diagnosed at later stage and with symptomatic disease. Tumors arise predominantly in the distal colon and rectum and have poorer histological features. Microsatellite and chromosome stable molecular pathway is frequently observed in EO-CRC. Survival data of EO-CRC is conflicting and younger patients tend to be treated more aggressively. It is important to identify high risk and have them screened appropriately to address increasing EO-CRC. Screening and treatment strategies for EO-CRC should be developed through further investigation of molecular mechanism and various environmental risk factors. In Korea, EO-CRC and late-onset CRC have both declined in recent several years, probably due to many screening colonoscopies in young population. Close observation and analysis of EO-CRC in Korea is necessary.
Colon ; Colonoscopy ; Colorectal Neoplasms ; Humans ; Incidence ; Korea ; Mass Screening ; Microsatellite Repeats ; Rectum ; Risk Factors ; United States ; Young Adult

Adult pancreatic hemangioma is an extremely rare disease, with only 22 cases reported since 1939. Pancreatic hemangioma has no specific symptoms, diagnostic imaging, or laboratory findings, making it difficult to be clinically suspected and diagnosed. The majority are confirmed after surgery. In this report, a 61-year-old woman presented with melena and showed multiple small hyper- vascular lesions in the pancreas. A pancreatic neuroendocrine tumor was suspected, and the patient underwent a distal pancreatectomy. The pathology examination and immunohistochemical study revealed a pancreatic hemangioma.

99mTc-galactosyl human serum albumin (Tc-GSA) is a radiopharmaceutical that binds to asialoglycoprotein receptors, which are specifically present in the hepatocyte membrane. Because these receptors are decreased in hepatic parenchymal damage, the degree of Tc-GSA accumulation in the liver correlates with findings of liver function test. Hepatic images were performed with Tc-GSA in patients with acute hepatic dysfunction by Amantia Subjunquillea poisoning, and compared with these of liver ultrasonography (USG). Tc-GSA (185 MBq, 3 mg of GSA) was injected intravenously, and dynamic images were recorded for 30 minutes. Time-activity curves for the heart and liver were generated from regions of interest for the whole liver and precordium. Degree of hepatic uptake and clearance rate of Tc-GSA were generated by visual interpretation and semiquantitative analysis parameters (receptor index: LHL15 and index of blood clearance: HH15). Visual assessment of GSA scintigraphy revealed mildly decreased liver uptake in all of subjects. The mean LHL15 and HH15 were 0.886 and 0.621, graded as mild dysfunction in 2, and mild to moderate dysfunction in 1 subject. In contrast, liver USG showed no remarkable changes of hepatic parenchyme. Tc-GSA scintigraphy was considered as a useful imaging modality in the assessment of the hepatic dysfunction.
Asialoglycoprotein Receptor ; Heart ; Hepatocytes ; Humans* ; Liver Function Tests ; Liver* ; Membranes ; Poisoning* ; Radionuclide Imaging* ; Serum Albumin* ; Ultrasonography*

BACKGROUND: An oral glucose tolerance test (OGTT) is the current method used for screening and diagnosis of gestational diabetes mellitus (GDM). OGTT is a relatively complicated procedure and is expensive. Thus, new strategies that do not require fasting or more than a single blood draw may improve the diagnosis of GDM and increase the rate of GDM testing. We investigated the utility of monitoring glycosylated hemoglobin (HbA1c) levels for the diagnosis of GDM. METHODS: The data from 992 pregnant women with estimated gestational ages ranging from 24 to 28 weeks were retrospectively reviewed. There were 367 women with plasma glucose levels > or =140 mg/dL 1 hour after a 50-g OGTT. GDM was diagnosed according to the Carpenter-Coustan criteria for a 3-hour 100 g OGTT. A HbA1c assessment was performed at the same time. RESULTS: We enrolled 343 women in this study, and there were 109 women with GDM. The area under the curve the receiver operating characteristic curve for HbA1c detection of GDM was 0.852 (95% confidence interval, 0.808 to 0.897). A HbA1c cutoff value > or =5.35% had maximal points on the Youden index (0.581). The sensitivity was 87.2% and the specificity was 70.9% for diagnosing GDM. A threshold value > or =5.35% indicated that 163 patients had GDM and that 68 (41.7%) were false positive. The positive predictive value was 58.3% at this threshold value. CONCLUSION: Despite substantial progress in methodology, HbA1c values cannot replace OGTT for the diagnosis of GDM.
Blood Glucose ; Diabetes, Gestational* ; Diagnosis* ; Fasting ; Female ; Gestational Age ; Glucose Tolerance Test ; Hemoglobin A, Glycosylated* ; Humans ; Mass Screening ; Pregnancy ; Pregnant Women ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity