As glaucoma progresses, the visual field changes continuously and the disk cupping 'enlarges progressively' At the terminal stage the visual field constrics concentrically and the disk cupping enlarges markedly with or without atrophic changes. Also many other ocular tissues run degenerative courses. Author studied 157 pat1ents(215 eyes) who visited Busan National University Hospital 'during the period from January 1976 to December 1980. The duration of follow-up ranged from 3 months to 3 years. Among the 215 glaucoma eyes terminal stage of primary glaucoma which was classified as author's criteria were 76 eyes(67 patients). The clinical analysis of the terminal stage of primary glaucoma were resumed as follows: 1. There were 83 patients(121 eyes, 56.3%) of primary glaucoma in total 157 glaucoma patients(215 eyes). 2. 61 eyes(80.3%) of the 76 eyes of terminal glaucoma showed ocular finding which disturbed visual acuiy. Those ocular findings were as follows: Bullous keratopathy(38.3%), lens sclerosis(9.2%). anterior chamber flare(11.8%), pigments on the corneal endothelium and anterior lens capsule(9.2%), vitreous floaters(1.3%), cataract(5.4%), corneal ulcer(1.3%). 3. Systemic diseases found in the terminal glaucoma patients were hypertension with cardiologic problems(6.5%), diabetes mellitus(1.6%), and thyrotoxicosis(1.6%). 4. 36 patients(58.1%) of the terminal glaucoma patients accompanied glaucoma in the opposite eye, and 14 patients(22.6%) were bilateral terminal glaucoma patients. 5. Medical treatment only was effective in 8 eyes(14.8%) and surgical treatments were effective in 30 eyes(76.9%) of the treated terminal glaucoma eyes. 6. The average duration from the time of initial appearance of the glaucomatous symptoms to the time diagnosed as terminal stage glaucoma was 2 years and 5 months in open-angle glaucoma and 50 days in angle-closure glaucoma.
Anterior Chamber ; Busan ; Endothelium, Corneal ; Follow-Up Studies ; Glaucoma* ; Glaucoma, Angle-Closure ; Glaucoma, Open-Angle ; Humans ; Hypertension ; Visual Fields

No abstract available.
Lymphangioma, Cystic*

This paper describes a case of agenesis of the right lung in a male neonate, who suffered respiratory difficulty. He was evaluated by plain X-ray, bronchography, lung perfusion scan, chest CT, and brain CT. After he died, autopsy was performed. The results revealed multiple anomalies which included cleft lip and palate, absence of left thumb and radius bone, hemivertebra between L1 and L2, arachnoid cyst in occipital lobe of brain. We report this case with brief review fo some related literature.
Arachnoid ; Autopsy ; Brain ; Bronchography ; Cleft Lip* ; Humans ; Infant, Newborn ; Lung* ; Male ; Occipital Lobe ; Palate* ; Perfusion ; Radius ; Thumb ; Tomography, X-Ray Computed

Absence or atresia of the canaliculus and punctum is rare. The primordium of the lacrimal passage which is derived from surface ectoderm is developed along the line of the cleft between the lateral nasal and the maxillary processes at about 10 mm. (5th week) embryo. At 15 mm. (6th week) embryo, it becomes detached from the surface ectoderm to form an irregular solid rod of cells; the epithelial cord thus formed represents the rudiments of the lacrimal passages. By bud-like cutgrowths from the upper extremity of the uppermost rod of cells, these are rudiments of the lacrimal canaliculi and they reach the epithelium of the lid margins at the 35 mm. embryo. During the 3rd month the central cells of the solid rod begin to disintegrate; the originally solid naso-lacrimal passages thus become canalized. Although the lumina of the canaliculi become patent during the 4th month, the lacrimal puncta do not open onto the lid margins until just before the lids separate during the 7th month. The three main types of developmental anomaly affecting the passages are gross changes; due to failure in the regular fusing of the nasal and maxillary processes, samller changes: due to an abnormal course being followed by the budding cells, and failures in canalization resulting in atresia. Authors presented 2 cases of absence of puncta combined with atresia of canaliculi which send to be resulted from failure in canalization.
Ectoderm ; Embryonic Structures ; Epithelium ; Upper Extremity

No abstract available.
Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Stroke*

Background: and PurposeInterhospital transfer is an essential practical component of regional stroke care systems. To establish an effective stroke transfer network in South Korea, an interactive transfer system was constructed, and its workflow metrics were observed. Methods: In March 2019, a direct transfer system between primary stroke hospitals (PSHs) and comprehensive regional stroke centers (CSCs) was established to standardize the clinical pathway of imaging, recanalization therapy, transfer decisions, and exclusive transfer linkage systems in the two types of centers. In an active case, the time metrics from arrival at PSH (“door”) to imaging was measured, and intravenous thrombolysis (IVT) and endovascular treatment (EVT) were used to assess the differences in clinical situations. Results: The direct transfer system was used by 27 patients. They stayed at the PSH for a median duration of 72 min (interquartile range [IQR], 38–114 min), with a median times of 15 and 58 min for imaging and subsequent processing, respectively. The door-to-needle median times of subjects treated with IVT at PSHs (n=5) and CSCs (n=2) were 21 min (IQR, 20.0–22.0 min) and 137.5 min (IQR, 125.3–149.8 min), respectively. EVT was performed on seven subjects (25.9%) at CSCs, which took a median duration of 175 min; 77 min at the PSH, 48 min for transportation, and 50 min at the CSC. Before EVT, bridging IVT at the PSH did not significantly affect the door-to-puncture time (127 min vs. 143.5 min, p=0.86). Conclusions The direct and interactive transfer system is feasible in real-world practice in South Korea and presents merits in reducing the treatment delay by sharing information during transfer.

PURPOSE: To evaluate the efficacy and complication of minimally invasive plate osteosynthesis (MIPO) technique for lateral malleolar fracture. MATERIALS AND METHODS: From January 2001 to December 2003, we had treated 13 cases of lateral malleolar fracture (AO-OTA classification, type A: 4, type B: 9) by MIPO technique and followed them up more than 1 year. Operation time, union time, radiologic alignment, range of motion of the ankle joint, functional results according to criteria of Meyer and complication were evaluated. RESULTS: After the final follow-up, all the fractures were healed without any second procedure, full-weight bearing ambulation was started in average 10 weeks. Any malunion was not observed by the inadequate bending of plate. Two patients felt a discomfort of ankle because the location of plate was lower than the tip of the lateral malleolus, but all the patients had excellent or satisfactory ankle functions. No deep infection or soft tissue compromise were observed at the last follow up. CONCLUSION: Minimally invasive plate osteosynthesis technique is safe and worthwhile method in management of lateral malleous fractures while avoiding the complications associated with conventional open plating methods.
Ankle ; Ankle Fractures ; Ankle Joint ; Classification ; Follow-Up Studies ; Humans ; Range of Motion, Articular ; Walking

PURPOSE: Although endovascular treatment is currently thought to only be suitable for patients who have pial arterial filling scores >3 as determined by multiphase computed tomography angiography (mpCTA), a cut-off score of 3 was determined by a study, including patients within 12 hours after symptom onset. We aimed to investigate whether a cut-off score of 3 for endovascular treatment within 6 hours of symptom onset is an appropriate predictor of good functional outcome at 3 months. MATERIALS AND METHODS: From April 2015 to January 2016, acute ischemic stroke patients treated with mechanical thrombectomy within 6 hours of symptom onset were enrolled into this study. Pial arterial filling scores were semi-quantitatively assessed using mpCTA, and clinical and radiological parameters were compared between patients with favorable and unfavorable outcomes. Multivariate logistic regression analysis was then performed to investigate the independent association between clinical outcome and pial collateral score, with the predictive power of the latter assessed using C-statistics. RESULTS: Of the 38 patients enrolled, 20 (52.6%) had a favorable outcome and 18 had an unfavorable outcome, with the latter group showing a lower mean pial arterial filling score (3.6±0.8 vs. 2.4±1.2, P=0.002). After adjusting for variables with a P-value of <0.1 in univariate analysis (i.e., age and National Institutes of Health Stroke Scale score at admission), pial arterial filling scores higher than a cut-off of 2 were found to be independently associated with favorable clinical outcomes (P=0.012). C-statistic analysis confirmed that our model had the highest prediction power when pial arterial filling scores were dichotomized at >2 vs. ≤2. CONCLUSION: A pial arterial filling cut-off score of 2 as determined by mpCTA appears to be more suitable for predicting clinical outcomes following endovascular treatment within 6 hours of symptom onset than the cut-off of 3 that had been previously suggested.
Angiography ; Humans ; Logistic Models ; National Institutes of Health (U.S.) ; Stroke ; Thrombectomy

BACKGROUND AND PURPOSE: To investigate the number and characteristics of patients eligible for endovascular treatment (EVT) determined using three different selection methods: clinical-core mismatch, target mismatch, and collateral status. METHODS: Using the data of consecutive patients from two prospectively maintained registries of university medical centers, the number and characteristics of patients according to the three selection methods were investigated and their correlation was analyzed. Patients with anterior circulation stroke due to occlusion of the middle cerebral and/or internal carotid artery and a National Institute of Health Stroke Scale (NIHSS) score of ≥6 points, who arrived within 8 hours or between 6 and 12 hours of symptom onset and underwent magnetic resonance imaging prior to EVT, were included. Collateral status was assessed using magnetic resonance perfusion-derived collateral flow maps. RESULTS: Three hundred thirty-five patients were investigated; the proportions of patients who were eligible and ineligible for EVT in all three selection methods were both small (n=85, 25.4%; n=54, 16.1%, respectively). The intercorrelation among the three selection methods was low (κ=0.235). The baseline NIHSS score and onset-to-selection time interval were associated with the presence of clinical-core mismatch, while the penumbra/core volume ratio and onset-to-selection time interval were related to target mismatch; none of these variables were associated with collateral status. The infarct core volume was associated with favorable profiles in all three selection methods. CONCLUSIONS: Although the application of individual selection methods resulted in favorable outcomes after EVT in clinical trials, there is a significant discrepancy in EVT eligibility depending on the selection method used.
Academic Medical Centers ; Carotid Artery, Internal ; Humans ; Magnetic Resonance Imaging ; Methods ; Prospective Studies ; Registries ; Stroke

Background: and Purpose An insertable cardiac monitor (ICM) has been demonstrated to be a useful tool for detecting subclinical atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS). This study aimed to identify the clinical predictors of AF in ESUS patients with ICMs. Methods: We retrospectively selected consecutive patients with an ICM implanted for AF detection following ESUS. The primary endpoint was defined as any AF episode lasting for longer than 5 min. The atrial ectopic burden (AEB) was calculated as the percentage of the number of conducted QRS from atrial ectopy on Holter monitoring. Results: This study included 136 patients. AF lasting ≥5 min was detected in 20 patients (14.7%) during a median follow-up period of 6.6 months (interquartile range, 3.3–10.8 months).AF patients had a higher AEB (0.20% vs. 0.02%,p<0.001) and a larger left atrial diameter (LAD, 41.0 mm vs. 35.3 mm, p<0.001) than those without AF. The areas under the receiver operating characteristic curves were 0.795 and 0.816 for the LAD and log-transformed AEB, respectively, for the best cutoff values of 38.5 mm for LAD and 0.050% for AEB. AF lasting ≥5 min was detected in 34.6% (9/26) of patients with LAD ≥38.5 mm and AEB ≥0.050%, and in 0% (0/65) of those with LAD <38.5 mm and AEB <0.050%. Conclusions AF was detected in a significant proportion of ESUS patients during a 6.6-month follow-up. The LAD and AEB are good predictors of AF and might be useful for AF risk stratification in ESUS patients.