The new method is described of extracting various types of cataracts intracapsularly by means of a pencil-shaped metal instrument, named Krwawicz's model cryoextractor. This is refrigerated in a mixture of dry ice and methyl alcohol so that when the ice-coated tip is applied to the lens, the capsule and the underlying cataractous masses adhere firmly to its ball-shaped end and an easy intracapsular extraction is ensured. Fifty extractions of various types of cataracts have been performed by this method. In 49 cases the cataract could be extracted intracapsularly. In only one case did the capsule rupture but it was possible to remove the capsule and lens mass almost completely. The results of the fifty extractions by this method are given.
Cataract Extraction* ; Cataract* ; Dry Ice ; Methanol ; Rupture

Background: The World Health Organization (WHO) proposed a global action plan for dementia and aimed to have 75% of their member states formulating National Dementia Plans (NDPs) by 2025. The Organization for Economic Cooperation and Development (OECD) proposed the ten key objectives of dementia policy in 2015. Among previous studies on NDPs, few studies have investigated measures for proper implementation of NDPs. This study aimed to compare the implementation basis and specific action plans of NDPs between the G7 countries and South Korea. Methods: We investigated the measures for proper implementation of the NDPs of G7 countries and South Korea. To compare the specific policy approaches, the seven action areas of the WHO action plan and the ten key objectives of dementia policy proposed by the OECD were integrated into 11 targets (prevention, diagnosis, awareness, caregiver support, appropriate environments, long-term care, health service, end-of-life care, care coordination, research and technology, information systems). Results: Although most NDPs included specific action plans of the 11 targets, caregiver support, safe environments, healthcare services, and end-of-life care were lacking in some NDPs. For implementation, some countries reinforced the policy priority of their NDPs by timely updates, evaluation, legislations, or head-of-state leadership. However, only three countries had a legislative basis, and three countries included outcome measures in their latest NDP. Conclusion Effective measures for feasible implementation are needed. The WHO should promote not only the establishment of NDPs, but also their proper implementation.

A case of Coats' disease in 15 years old boy was presented with some clinical observation. This is a rare unilateral retinal disorder with hemorrhagic and exudative properties affecting otherwise healthy young boys. A brief review of literatures has also been described.
Adolescent ; Humans ; Male ; Retinaldehyde

Objective: The Clinical Data Interchange Standards Consortium (CDISC) proposed outcome measures for clinical trials on Alzheimer’s disease (AD) in the Therapeutic Area User Guide for AD (TAUG-AD). To investigate how well the clinical trials on AD registered in the ClinicalTrials.gov complied with the recommendations on outcome measures by the CDISC. Methods: We compared the outcome measures proposed in the TAUG-AD version 2.0.1 with those employed in the protocols of clinical trials on AD registered in ClinicalTrials.gov. Results: We analyzed 101 outcome measures from 305 protocols. The TAUG-AD listed ten scales for outcome measures of clinical trials on AD. The scales for cognition, activities of daily living, behavioral and psychological symptoms of dementia, and global severity listed in TAUG-AD were most frequently employed in the clinical trials on AD. However, TAUG-AD did not include any scale on quality of life. Also, several scales such as Montreal Cognitive Assessment, Alzheimer’s Disease Cooperative Study–Activities of Daily Living, and Cohen- Mansfield Agitation Inventory not listed in the TAUG-AD were commonly employed in the clinical trials on AD and changed over time. Conclusion To properly standardize the data from clinical trials on AD, the gap between the TAUG-AD and the measures employed in real-world clinical trials should be filled.

Pelvic organ prolapse (POP) is bulging of one or more of the pelvic organs into the vagina and triggered by multiple causes. It is a very common disorder, especially among older women. POP is characterized by protrusion of the presentation part visible by the naked eye, and problems with urination or bowel movements. POP can be diagnosed based on the onset of symptoms and a pelvic exam, and management options include medical and surgical treatment. Although medical treatment cannot correct the abnormal herniation of the pelvic structures, this can help alleviate symptoms. One of the disadvantages of surgical interventions is recurrence, and advances in surgical techniques have decreased recurrence rates of POP. Therefore, author will explain the gynecology and urology approach and treatment.
Cystocele ; Female ; Gynecological Examination ; Gynecology ; Humans ; Pelvic Organ Prolapse ; Rectocele ; Recurrence ; Urination ; Urology ; Vagina

OBJECTIVE: This study was to investigate the factors that influence the propensity of Koreans in choosing care settings of dementia patients. METHODS: This study analyzed the data from the '2014 Nationwide Survey on Dementia Awareness of Koreans' that was conducted by the National Institute of Dementia. Korean's perception of care burden for dementia was measured with grading on its types. Also its influences on preference for care between facilities and homes were evaluated using multivariate analysis with socio-demographic characteristics. RESULTS: In terms of preferred care settings, respondents preferred facilities over homes in case of themselves and their family, respectively 77.5% and 68.2%. The preference for facilities was significantly influenced by the respondents' age for both themselves and their family. Additionally, the perception of relatively higher emotional and physical burden compared to economic burden significantly influenced preference for facilities for their family. CONCLUSION: Improving public awareness and setting-up a practical social supporting system are needed to reduce emotional and physical burden as well as economic burden of dementia. Furthermore, building up an appropriate and safer communities for dementia patients and their caregivers is much demanded for reducing their burdens.
Caregivers ; Surveys and Questionnaires ; Dementia* ; Humans ; Multivariate Analysis

PURPOSE: To compare and evaluate the total and internal aberrations measured by two aberrometers: the laser ray tracing aberrometer (iTrace, Tracey Technology) and the automatic retinoscope aberrometer (OPD Scan, Nidek). METHODS: A total of 54 healthy eyes were enrolled in the study. Following pupil dilation, aberrations were measured with the iTrace and OPD Scan. We compared the aberrations obtained from measurements obtained at pupillary diameters of 4 mm and 6 mm with the OPD Scan and iTrace. Aberrations of internal optics and total aberrations were compared for the two aberrometers. For each aberrometer and each eye, the averaged Zernike data were used to calculate various root-mean-square (RMS) data. These parameters, together with the refractive parameters, were then analyzed and complimented by paired t-tests. RESULTS: At a pupil diameter of 4 mm, the number of total aberrations in the entire eye showed significant differences for the mean values of spherical aberrations (Z4,0) obtained with the OPD Scan and iTrace aberrometers (p=0.001). Aberrations of the internal optics showed significant differences in the mean values of total RMS, coma (Z3,-1), and trefoil (Z3,3) between the iTrace and OPD Scan (p<0.001, p=0.01, p<0.001) for the same pupil diameter of 4 mm. At a pupil diameter of 6 mm, the two instruments showed a similar number of total aberrations. Aberrations of the internal optics showed significant differences in the mean values of total RMS, spherical aberration (Z4,0), and coma (Z3,-1) between the two devices (p<0.001, p=0.01, p<0.001). CONCLUSIONS: The iTrace and OPD Scan showed the largest number of differences for aberrations of internal optics rather than total aberrations for both pupil diameters. These results suggest that in healthy eyes, the two aberrometers may vary in some details. The aberrometers showed more agreement at a pupil diameter of 6 mm compared to 4 mm.
Adult ; Diagnostic Techniques, Ophthalmological/*instrumentation ; Humans ; Pupil/physiology ; Refractive Errors/*diagnosis ; Reproducibility of Results

Myotonic dystrophy 1 (DM1) is a multi-system disorder characterized by endocrine defects that include testicular and tubular atrophy, oligospermia and azoospermia, and increased follicle-stimulating hormone levels. We describe a rare case of DM1 presenting as infertility in a 29-year-old man.
Adult ; Atrophy ; Azoospermia ; Follicle Stimulating Hormone ; Humans ; Infertility ; Infertility, Male ; Male ; Myotonic Dystrophy ; Oligospermia

BACKGROUND AND OBJECTIVES: Hypercholesterolemia is a key factor in the development of atherosclerosis. We sought to evaluate the relation between hypercholesterolemia and plaque composition in patients with coronary artery disease. SUBJECTS AND METHODS: Study subjects consisted of 323 patients (mean 61.5 years, 226 males) who underwent coronary angiography and virtual histology-intravascular ultrasound examination. Patients were divided into two groups according to total cholesterol level: hypercholesterolemic group (> or =200 mg/dL, n=114) and normocholesterolemic group (<200 mg/dL, n=209). RESULTS: Hypercholesterolemic patients were younger (59.7+/-13.3 years vs. 62.6+/-11.5 years, p=0.036), than normocholesterolemic patients, whereas there were no significant differences in other demographics. Hypercholesterolemic patients had higher corrected necrotic core volume (1.23+/-0.85 mm3/mm vs. 1.02+/-0.80 mm3/mm, p=0.029) as well as percent necrotic core volume (20.5+/-8.5% vs. 18.0+/-9.2%, p=0.016) than normocholesterolemic patients. At the minimal lumen area site, percent necrotic core area (21.4+/-10.5% vs. 18.4+/-11.3%, p=0.019) and necrotic core area (1.63+/-1.09 mm2 vs. 1.40+/-1.20 mm2, p=0.088) were also higher than normocholesterolemic patients. Multivariate linear regression analysis showed that total cholesterol level was an independent factor of percent necrotic core volume in the culprit lesion after being adjusted with age, high density lipoprotein-cholesterol , hypertension, diabetes mellitus, smoking and acute coronary syndrome (beta 0.027, 95% confidence interval 0.02-0.053, p=0.037). CONCLUSION: Hypercholesterolemia was associated with increased necrotic core volume in coronary artery plaque. This study suggests that hypercholesterolemia plays a role in making plaque more complex, which is characterized by a large necrotic core, in coronary artery disease.
Acute Coronary Syndrome ; Atherosclerosis ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Demography ; Diabetes Mellitus ; Humans ; Hypercholesterolemia ; Hypertension ; Linear Models ; Smoking

BACKGROUND AND OBJECTIVES: Mechanical circulatory support with extracorporeal membrane oxygenation (ECMO) and ventricular assist device has always been the optimal choice for treating the majority of medically intractable low cardiac output case. We retrospectively investigated our institution's outcomes and variables associated with a high risk of mortality. SUBJECTS AND METHODS: From 1999 to 2014, 86 patients who were of pediatric age or had grown-up congenital heart disease underwent mechanical circulatory support for medically intractable low cardiac output in our pediatric intensive care unit. Of these, 9 grown-up congenital heart disease patients were over 18 years of age, and the median age of the subject group was 5.82 years (range: 1 day to 41.6 years). A review of all demographic, clinical, and surgical data and survival analysis were performed. RESULTS: A total of 45 (52.3%) patients were successfully weaned from the mechanical assist device, and 25 (29.1%) survivors were able to be discharged. There was no significant difference in results between patients over 18 years and under 18 years of age. Risk factors for mortality were younger age (<30 days), functional single ventricle anatomy, support after cardiac operations, longer support duration, and deteriorated pre-ECMO status (severe metabolic acidosis and increased levels of lactate, creatinine, bilirubin, or liver enzyme). The survival rate has improved since 2010 (from 25% before 2010 to 35% after 2010), when we introduced an upgraded oxygenator, activated heart transplantation, and also began to apply ECMO before the end-stage of cardiac dysfunction, even though we could not reveal significant correlations between survival rate and changed strategies associated with ECMO. CONCLUSION: Mechanical circulatory support has played a critical role and has had a dramatic effect on survival in patients with medically intractable heart failure, particularly in recent years. Meticulous monitoring of acid-base status, laboratory findings, and early and liberal applications are recommended to improve outcomes without critical complication rates, particularly in neonates with single ventricle physiology.
Acidosis ; Bilirubin ; Cardiac Output, Low* ; Creatinine ; Critical Care* ; Extracorporeal Membrane Oxygenation ; Heart Defects, Congenital ; Heart Failure ; Heart Transplantation ; Heart-Assist Devices ; Humans ; Infant, Newborn ; Intensive Care Units* ; Lactic Acid ; Liver ; Mortality ; Oxygen ; Oxygenators ; Physiology ; Resuscitation ; Retrospective Studies ; Risk Factors ; Survival Rate ; Survivors