Purpose: This study aimed to investigate the impact of delayed retinal clinical care during the COVID-19 pandemic on the severity of proliferative diabetic retinopathy (PDR) and drivers of follow-up delay. We compared disease severity and follow-up rates of PDR patients requiring vitrectomy to those managed nonsurgically, and identified factors associated with need for vitrectomy. Methods: The study included 739 patients diagnosed with PDR between January 1, 2018, and March 4, 2021, categorized into two groups based on outcome: vitrectomy nonvitrectomy. Statistical methods such as t-tests and chi-square tests were used to analyze differences in disease severity and follow-up rates before and after COVID-19 shutdown. A multivariate regression evaluated factors leading to vitrectomy by comparing initial ETDRS (Early Treatment of Diabetic Retinopathy Study) DR staging, disease stability, DR progression, proliferative complications, appointment intervals, follow-up variance, rescheduling rate, and no-show rate. Results: Of the 739 patients, 202 required vitrectomy, 537 were managed nonsurgically. The vitrectomy group had more severe or unstable disease before shutdown. The interval between patient visits preshutdown was 29.76 ± 45.11 days in the vitrectomy group and 40.23 ± 56.73 days in the nonvitrectomy group (p < 0.001). Both groups experienced a significant increase in appointment intervals after shutdown, with the vitrectomy group having a greater increase. Both groups had significantly increased rescheduling rate and minimally increased no-show rate. Patient-directed rescheduling was the main driver of appointment delays. Disease factors, such as tractional retinal detachment and higher ETDRS DR staging, increased the odds of vitrectomy, while appointment burden and follow-up variability had a minimal impact. Conclusions Patients with more severe PDR and greater delay in appointments due to the pandemic were more likely to require vitrectomy for proliferative complications. Patient-directed rescheduling was identified as the main driver of care delays, as opposed to clinic-directed rescheduling. This study highlights the importance of maintaining regular follow-up appointments for PDR patients during pandemics.

No abstract available.
Biopsy, Fine-Needle* ; Diagnostic Errors* ; Thyroid Gland* ; Thyroid Neoplasms*

Since urethral Foley catheterization is usually easy and safe, serious complications related to this procedure have been rarely reported. Herein, we describe a case of intraperitoneally placed urethral catheter via verumontanum presenting as intraperitoneal bladder perforation in a chronically debilitated elderly patient. A 82-yr-old male patient was admitted with symptoms of hematuria, lower abdominal pain after traumatic Foley catheterization. The retrograde cystography showed findings of intraperitoneal bladder perforation, but emergency laparotomy with intraoperative urethrocystoscopy revealed a tunnel-like false passage extending from the verumontanum into the rectovesical pouch between the posterior wall of the bladder and the anterior wall of the rectum with no bladder injury. The patient was treated with simple closure of the perforated rectovesical pouch and a placement of suprapubic cystostomy tube.
Aged, 80 and over ; Cystostomy ; Humans ; Male ; Peritoneum ; Rupture/diagnosis ; Urinary Bladder/*injuries/*surgery ; *Urinary Catheterization

There have been some reports about formation of free radical species in aqueous humor after excimer laser photorefractive keratectomy(PRK). We investigated whether there exists an increase of nitric oxied(NO) level in aqueous humor after excimer laser treatment. Of the 41 albino rabbits(81 eyes) used for this study, 25 eyes served as controls. The remaining 56 eyes were divided into three groups, i.e., a group with its epithelium removed mechanically(3 eyes), -6.0D PRK group(24 eyes) and -12.0D PRK group(29 eyes). After varing time intervals following excimer laser treatment, aqueous NO concentration was determined with ELISA method using Griess reagent. The mean aqueous NO concertration was 101.83ng/ml in normal control group and showed no difference(107.00ng/ml) from that of mechanically abladed group, Aqueous NO was increased 30 min after PRK in both groups compared to normal(-6.0D : 218.67ng/ml, -12.0D : 198.68ng/ml) and maintained at one hour postoperatively. Eyes with -12.0D ablation still while eyes with -6.0D ablation showed no difference from normal. Six hours after PRK, aqueous NO was returned to the normal level in both groups of PRK. The results of this study showed that excimer laser PRK induced NO production in aqueous humor, and the more extensive amount of excimer laser applied, the longer time would be taken to restore the normal NO level. It seems that such an elevation of NO level could be one of the factors that cause temporary corneal stromal edema or anterior chamber reaction after excimer laser PRK.
Anterior Chamber ; Aqueous Humor ; Edema ; Enzyme-Linked Immunosorbent Assay ; Epithelium ; Lasers, Excimer* ; Nitric Oxide*

No abstract available.
Knee Joint* ; Knee*

Purpose: Visual impairment from retinal re-detachment could be debilitating. The aim of this review is to evaluate the role of 360° laser retinopexy on success rate of rhegmatogenous retinal detachment (RRD) repair by a meta-analysis study. Methods: The PubMed, Scopus, and the Cochrane Library databases were searched comprehensively from the date of database inception to January 2021, evaluating the role of 360° laser retinopexy in visual and anatomical success rate of RRD repair. This review was conducted based on the preferred reporting items for systematic review and meta-analysis (PRISMA) protocols. Results: Among 202 articles screened for eligibility, six studies were found to be eligible for inclusion in our final analysis. Our meta-analysis demonstrates that prophylactic treatment with circumferential laser photocoagulation has no significant effect on the initial rate of retinal re-detachment or final best-corrected visual acuity following pars plana vitrectomy repair of RRD. Subgroup analysis of studies (n = 3) with 23-gauge pars plana vitrectomy, however, favors attachment rate in patients undergoing 360° prophylactic laser treatment. Conclusions Three hundred and sixty degree laser retinopexy appears to have favorable outcomes in patients undergoing 23-gauge retinal detachment repair. This protective effect, however, is not apparent with inclusion of 20-gauge vitrectomy studies.

Purpose: Visual impairment from retinal re-detachment could be debilitating. The aim of this review is to evaluate the role of 360° laser retinopexy on success rate of rhegmatogenous retinal detachment (RRD) repair by a meta-analysis study. Methods: The PubMed, Scopus, and the Cochrane Library databases were searched comprehensively from the date of database inception to January 2021, evaluating the role of 360° laser retinopexy in visual and anatomical success rate of RRD repair. This review was conducted based on the preferred reporting items for systematic review and meta-analysis (PRISMA) protocols. Results: Among 202 articles screened for eligibility, six studies were found to be eligible for inclusion in our final analysis. Our meta-analysis demonstrates that prophylactic treatment with circumferential laser photocoagulation has no significant effect on the initial rate of retinal re-detachment or final best-corrected visual acuity following pars plana vitrectomy repair of RRD. Subgroup analysis of studies (n = 3) with 23-gauge pars plana vitrectomy, however, favors attachment rate in patients undergoing 360° prophylactic laser treatment. Conclusions Three hundred and sixty degree laser retinopexy appears to have favorable outcomes in patients undergoing 23-gauge retinal detachment repair. This protective effect, however, is not apparent with inclusion of 20-gauge vitrectomy studies.

PURPOSE: We retrospectively reviewed the cases of female stress incontinence at our institution to evaluate the value of VLPP(valsalva leak point pressure) in predicting surgical outcome of BNS(bladder neck suspension). MATERIALS AND METHODS: Ninety-four female patients with stress incontinence who underwent BNS after urodynamic study were investigated retrospectively. Surgical outcomes and patient?s satisfaction were assessed by questionnaires. Surgical outcomes were then analyzed in relation to VLPP and MUCP(maximal urethral closing pressure). Follow-up averaged 27 months. RESULTS: Mean age was 50 years and mean parity was 2.9. Urinary incontinence completely disappeared in 36 patients(38.2%), significantly improved in 29 patients(30.9%), failed in 29 patients(30.9%). There was a significant relationship between VLPP and failure rate. The failure rate was 44.8%(p=0.015) in patients with low VLPP(< or =60cmH2O) and 36.4%(p=0.67) with low MUCP(< or =20cmH2O). CONCLUSIONS: We conclude that VLPP is superior to MUCP in predicting surgical outcome after bladder neck suspension for female stress incontinence. This study demonstrates that bladder neck suspension is not a effective procedure for surgical correction of intrinsic sphincter deficiency, therefore another treatment modality should be considered. VLPP is a useful guide in selecting appropriate surgical modality on female stress urinary incontinence.
Female* ; Follow-Up Studies ; Humans ; Neck* ; Parity ; Surveys and Questionnaires ; Retrospective Studies ; Urinary Bladder* ; Urinary Incontinence* ; Urodynamics

A clinieal Observation was done on the 110 cases (male; 52 cases, female; 58 cases) of duodenitis under the gastroduodenoscopic examination among the patients who were performed endoscopic examination because of seeking for the cause of dyspepsia period from Aug. 1981 to Sep. 1981 at Department of lnteral Medicine of BNUH. The results were summerized as follow 1) Normal finding(Grade 0) was highest as 40% in the incidence according to grade of duodenits. Next was moderate (Grade II & II) as 24. 5%, the 3rd was mild(Grade I) as 20% and lowest in severe(Grade IV) duadenitis as 15.5%, 2) Sex distribution of duodenitis showed 37 cases in male and 29 cases in female. And male was slightly higher in incidence than female. 3) Age distribution of duodenitis revealeii 3rd decade and 4th decade were highest in incidence, 30 cases and 28 cases respectively. The order of frequency was 5th decade, 6th decade, 1st decade and 7th decade. 4) Duodenitis was slightly higher in after 4th decade than before 4th decade. 5) The 56 cases of duodenitis except for 1 case were aasociated with gastroduodenal diseases such as gastritis, peptic ulcer or gastric carcinoma. Association of gastritis is highest as 79. 4%. 6) Acurracy of diagnosis in duodenitis on X-ray study was 3 cases in 20 cases. Generally X-ray study was little value in diagnosis of duodenitis.
Age Distribution ; Diagnosis ; Duodenitis* ; Dyspepsia ; Female ; Gastritis ; Humans ; Incidence ; Male ; Peptic Ulcer ; Sex Distribution

PURPOSE: The purpose of this study was to compare the effects of resiniferatoxin (RTX) and botulinum toxin (BTX) on the bladder detrusor function in a cyclophosphamide (CYP)-induced cystitis rat model. MATERIALS AND METHODS: Sprague-Dawley rats were divided into 5 groups (1: saline treated, 2: CYP and BTX treated, 3: CYP and RTX treated, 4 and 5: CYP treated and sham operated as the counterpart of groups 2 and 3, respectively, with normal saline). 100mg/kg CYP was injected every third day for five weeks. Cystometrograms were performed after the BTX and RTX treatments. RESULTS: 1. The normal control group and the CYP-treated only group. In the CYP-treated group, the time of micturition frequency, the maximal detrusor pressure on the cystometergram (Pvesmax at CMG), the maximal detrusor pressure on the pressure-flow study (Pvesmax at pr/flow) and the episodes of irregular contractions were increased. 2. The CYP-only group and the CYP/BTX or CYP/RTXtreated groups. In the CYP/BTX or CYP/RTX treated groups, the time of micturition frequency, the Pvesmax at CMG, the Pvesmax at pr/flow and the episode of irregular contractions were decreased. 3. The CYP/BTXtreated group and the CYP/ RTXtreated group. There was no statistically significant difference between the two groups regarding micturition frequency, the PvesMax at CMG and the PvesMax at pr/flow, the Dhfo and the episodes of involuntary contractions (p>0.05). CONCLUSIONS: Intravesical administration of BTX or RTX blocked the CYP-induced detrusor overactivity as was shown by the restoration of the micturition frequency, the intravesical pressure and the involuntary contraction episodes to a control level. There was no statistically significant difference between the two groups regarding the urodynamic parameters.
Administration, Intravesical ; Animals ; Botulinum Toxins* ; Cyclophosphamide* ; Cystitis ; Models, Animal ; Rats* ; Rats, Sprague-Dawley ; Urinary Bladder* ; Urination ; Urodynamics