PURPOSE: To prospectively investigate the change of clinical manifestations after 1 year of administration of anthocyanoside (Tagen-F(R)) to patients with NPDR-associated macular edema. METHODS: One hundred seventy-five eyes in 88 patients were enrolled in this study, at 5 centers, from March, 2005 to October, 2005. Patients took 3 capsules of Vaccinium myrtillus extract (170 mg/capsule, Tagen-F(R), Kukje pharmaceutical) per day. The primary endpoints were corrected visual acuity and contrast sensitivity which were checked at 2 months following the beginning of treatment [East 1]. The secondary endpoints were the number of hard exudates, microaneurysms, leaking points and the changes of foveal thickness. These were examined at the beginning of, 6 months after, and 12 months after treatment. RESULTS: Corrected visual acuity showed no significant changes during 12 months. Contrast sensitivity improved gradually, especially in 12, 16 cycles per degree [East 2]. There was no statistically significant changes in the numbers of hard exudates, microaneurysms, and leaking points. Foveal thickness measured by OCT was maintained and there was no aggravation of macular edema. CONCLUSIONS: There was marked improvement of contrast sensitivity in patients with NPDR after 1 year of administration of anthocyanoside (Tagen-F(R)), and it might contribute to the quality of vision and the satisfaction of patients. Visual acuity and macular edema were maintained without aggravation.
Anthocyanins ; Capsules ; Contrast Sensitivity ; Diabetic Retinopathy ; Exudates and Transudates ; Eye ; Humans ; Macular Edema ; Prospective Studies ; Vaccinium myrtillus ; Vision, Ocular ; Visual Acuity

PURPOSE: To investigate the effects of repeated photodynamic therapy (PDT) for subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD) in Korean patients. METHODS: Clinical data of patients who were treated with repeated (3 times or more) PDT for subfoveal choroidal neovascularization secondary to AMD and followed up for more than 6 months were collected from 17 hospitals around the country. Visual outcomes at 12 and 24 months, follow-up were compared between subtypes of choroidal neovascularization. The factors related to final visual prognosis and PDT-related adverse effects were evaluated. RESULTS: 244 patients (244 eyes) were recruited (male: 60%, age: 67.7+/-9.1 years). The portion of patients with predominantly classic, minimally classic, and occult without classic choroidal neovascularization was 57%, 13%, and 24%, respectively and that of patients with visual improvements or less than moderate visual loss at 24 months follow-up were 28%, 38%, 30% and 47%, 56%, and 65%, respectively. Baseline visual acuity and age were significantly related to the final visual prognosis (p<0.05). PDT-related adverse events developed in 15 (6.1%) patients, but most were mild and transient. CONCLUSIONS: Repeated PDT for subfoveal choroidal neovascularization secondary to AMD has effects comparable to those of previous prospective, controlled trials without any significant safety concerns in Korea.
Choroid* ; Choroidal Neovascularization* ; Follow-Up Studies ; Humans ; Korea ; Macular Degeneration* ; Photochemotherapy* ; Prognosis ; Visual Acuity

PURPOSE: The objectives of this study are to compare the hospital employees' and patients' recognition and attitudes toward the opening of the medical services market, to analyze the differences between hospital employees and patients on the factors in selecting a foreign hospital. MATERIALS AND METHODS: This study collected and analyzed data using systematic questionnaires that were self-administered by employees and outpatients to compare their recognition of the opening of the medical services market and the factors involved in selecting a foreign hospital. RESUTLS: Employees exhibited a higher level of recognition than the patients. Reasons for agreement were to ensure the right of selection for both the employees and patients. Reasons for disagreement, however, were split between the two groups: degraded public characteristics of medical services, for employees; and expensive medical fees, for patients. The most urgent task to prepare for the opening of the medical services market is the improvement of the diagnosis and treatment technologies for employees, and improvement of the services provided by hospital staff for patients. CONCLUSION: Korean hospitals shall need to improve their diagnosis and treatment technologies and provide medical services of high quality in order to compete with foreign hospitals.

Background: By reviewing experiences and lessons from results of main studies such as systematic review of articles and meta- analysis, and the current situation and trend in the field of cataract and refractive surgery, we proposed practical cases about objective and scientifically evident approaches in process of developing cataract clinical practice guideline in Korea. Methods: Development of cataract clinical practice guideline composed of constructing development team, reviewing guideline- associated articles, conducting meta-analysis and survey about practice behaviors, and having workshop and council. Meta-analysis composed of search and collection of article published within current five years, selection of review principles, development of article assessment form, and investigation of practical variation by qualitative and quantitative meta-analysis. Based on Medline, Meta-analysis was conducted about three topics of IOP (Intra-ocular pressure) changes after inserting each healon, and comparison results after cataract surgery by incision point and occurrence patterns of acquired cataract by types of intraocular lens. Questionnaire survey was conducted about practice behaviors focused on main procedures and surgeries related to cataract. For developing and using clinical practice guideline, we developed a draft which was reviewed by each sub-ophthalmology society, opened symposiums and workshop, and developed final draft. Results: There was no significant difference between IOP (Intra-ocular pressure) changes after inserting each healon. After reviewing article about results after cataract surgery by incision point, we found that we couldn't conduct quantitative meta-analysis because surgeries method, incision lengths, measuring methods, and points at measuring showed different pattern. Occurrences of cataract in 24 months after cataract surgery between 'PMMA', 'Silicone', and 'Acrylic' group showed significant difference. Result of questionnaire survey showed that there was many variations on cataract clinical practice behaviors. Conclusions: Although we were lacking in articles, we could propose partial objective evidences for development of cataract clinical practice guideline. And we found that systematic researches and surveys should be conducted for more objective evidences.
Cataract* ; Education ; Hyaluronic Acid ; Korea* ; Lenses, Intraocular ; Surveys and Questionnaires* ; Refractive Surgical Procedures

OBJECTIVE: We wanted to review the usefulness of ultrasonography (US) for the diagnosis of appendicitis and to evaluate the diagnostic accuracy of US according to patients' and researchers' characteristics. MATERIALS AND METHODS: The relevant Korean articles published between 1985 and 2003 were included in this study if the patients had clinical symptoms of acute appendicitis. The histopathologic findings were the reference standard and the data were presented for 2x2 tables. Articles were excluded if patients had no sonographic signs of appendicitis according to graded-compression US. Two reviewers independently extracted the data on study characteristics. The Hasselblad method was used to obtain the combined estimates of sensitivity and specificity for the performance of US. RESULTS: Twenty-two articles (2, 643 patients) fulfilled all inclusion criteria. The estimate of d calculated by combining the sensitivity and specificity was 2.0054 (95% confidence interval [CI]: 1.8553, 2.1554) by a random effects model. The overall sensitivity and specificity (95% CI) were 86.7% (85.4 to 88.0), and 90.0% (88.9 to 91.2), respectively. According to the subgroup meta-analysis by patients' characteristics, the d estimate (95% CI) of dominantly younger age, male, and highly clinical suggestive group for US was 2.2388 (1.8758 to 2.6019), 2.7131 (2.2493 to 3.1770), and 2.4582 (1.7387 to 3.1777), respectively. Also, according to subgroup meta-analysis by researchers' characteristics, the d value (95% CI) for US done by diagnostic radiologists and gray-scale was 2.0195 (1.7942 to 2.2447) and 2.2630 (1.8444 to 2.6815). CONCLUSION: This evidence suggests that US may be useful for the diagnosis of acute appendicitis, especially when patients are younger age, male, and highly clinical suggestive.
Sex Factors ; Sensitivity and Specificity ; Middle Aged ; Male ; Infant ; Humans ; Female ; Child, Preschool ; Child ; Appendicitis/*ultrasonography ; Aged, 80 and over ; Aged ; Age Factors ; Adult ; Adolescent ; Acute Disease

We performed a meta-analysis using results in the Korean literatures to determine whether laparoscopic appendectomy (LA) or open appendectomy (OA) provide the better outcome in possible acute appendicitis patients. To perform the meta-analysis, an extensive literature search was conducted, giving priority to the Journal of the Korean Surgical Society, and domestic literature in its search database, published since January 1993, to ascertain the usefulness of LA in the treatment of acute appendicitis. The criteria used for the quality evaluation were as follows: 1) study subjects must have been evaluated clinically for suspected acute appendicitis, and 2) articles were included only if sufficient data (e.g. patient number, mean and standard deviation of patient outcome variables) were available regarding patient outcomes for LA or OA treated appendicitis. Of the 136 articles retrieved, 8 studies (1, 258 patients) were selected for quantitative meta-analysis. Because insufficient data was available in some studies, operating time and hospitalization days were assessed for all 8 studies, but the time required to return to full functioning was assessed for only 3 studies. Overall effect size estimates were calculated using a random effect model for four patient outcomes (operating time, Q=38.6699, p < 0.001; length of stay, Q=19.3876, p < 0.001; postoperative hospital stay, Q=20.9164, p < 0.001; and return time to full functioning, Q=41.5061, p < 0.001). Because the overall effect size for operating time was -0.3218 (95% confidence interval [CI] -0.6108 to -0.0328), LA operating time was significantly greater than that of OA. In addition, a significant difference was found between the two modalities in terms of the length of hospital stay. Overall effect size in terms of the time required to return to full functioning was 1.9757 (95% CI 1.0066 to 2.9448), and LA reduced the time required by about 2 days versus OA. Considering the overall odds ratio (0.33) and 95% CI (0.20 to 0.55) the incidence of wound infection was significantly lower in LA than in OA. This review of the published evidence suggests that LA is more useful for treating acute appendicitis, especially when perforated appendicitis is suspected.
Acute Disease ; Appendectomy/*methods ; Appendicitis/*surgery ; Human ; Korea ; *Laparoscopy ; Support, Non-U.S. Gov't

PURPOSE: Temporary deafferentation (TD) by local anesthesia in small parts of the body induces an immediate and reVersible reorganization of the receptive field (RF). It is thought that an adaptation for deafferentation would occur in the visual system. Therefore, in this study, simultaneous multi-single unit recording (SMSUR) from visual cortex (VI cortex) of rats have been carried out to characterize; 1) the TD-induced changes in the populational activities of single neurons, 2) the alteration of the neural network among neurons in each area during TD and 3) the synaptic mechanism underlying the neuronal plasticity of the visual system. METHODS: Using four channels of a multi-electrode made from tungsten microwire, the neuronal activities (evoked responses and spontaneous activities) and networks in the VI cortex of anesthetized rats have been investigated. In this study, TD was induced by a retrobulbar injection of lidocaine (2%, 0.1 ml). RESULTS: After the induction of TD, the cortical neurons showed reversed changes in their evoked reoponses. The induction of TD suppressed the activities of the target cells in the VI cortex. However, TD also caused facilitation of the activities of the neighboring neurons. The spontaneous activities of the neighboring neurons were also gradually facilitated after the induction of TD and then gradually recovered to their initial control period values. CONCLUSIONS: The results from the present study suggest that; 1) TD-induced plasticity of the central visual system involving the VI cortex may be due to disinhibition of the lateral inhibition and 2) the spontaneous activities of the VI cortical neurons, as well as evoking responses, may be involved in the TD-induced visual plasticity of anesthetized rats.
Anesthesia, Local ; Animals ; Electrophysiology ; Lidocaine ; Neuronal Plasticity ; Neurons ; Plastics ; Rats* ; Tungsten ; Visual Cortex*

PURPOSE: Electrically evoked potential (EEP) was recorded in rabbits with polyimide-based, multichannel, microelectrode array (MEA) in their eyes, and was compared with the visual evoked potential (VEP) by flash light. METHODS: VEP was recorded under full-field flash light stimulation by 0. 6 J at 2 Hz, while EEP was recorded under electrical current stimulation of the retina by MEA. Latencies and shapes of N1, P100 and N2 in each evoked potential were compared. RESULTS: EEP was recorded in four of six rabbits. N1, P100 and N2 were observed in EEP on the electrical retina stimulation over 2.5 mA, and they resembled those of VEP. However, N1, P100 and N2 of EEP showed shorter latencies than those of VEP, by 15.1 msec (32.9%), 76.8 msec (38.3%) and 99.7 msec (60.1%) respectively. CONCLUSIONS: EEP by electrical retina stimulation with MEA was similar to VEP, indicating that MEA is suitable for the development of the artificial retina prototype. The shorter latencies of EEP should be considered in the parameters of the electrical stimulation of the retina.
Electric Stimulation ; Evoked Potentials* ; Evoked Potentials, Visual ; Microelectrodes ; Multiple Endocrine Neoplasia Type 1 ; Rabbits* ; Retina ; Retinaldehyde*

OBJECTIVE: This study was performed to be evaluated the adequacy on DRG classification in Obstetric group and analyzed the difference for medical benefit payment from the insurance and total medical reimbursement according to complication and age in vaginal delivery group and Cesarean section group. METHODS: This study has been analyzed for medical benefit payment from the insurance and total medical reimbursement of patients from University of hospital since Feburary 1999 to December 2000 and the data from Health Insurance Review Agency since Feburary 2001 to July 2001. RESULTS: Since these cases were not reported even 1 case in Korea, there were 113 cases needed to be deleted in DRG classification disease group. In the evaluation of disease severity for DRG classification disease group, there were 11 cases should be added to severe complicating diagnosis, 5 cases should be removed from severe complicating diagnosis, and 6 cases should be added to moderate complicating diagnosis in vaginal delivery and Cesarean section group. Medical benefit payment from the insurance and total medical reimbursement in the group with having severe complication were significantly higher than in the group without complication in Cesarean section group. Medical benefit payment from the insurance and total medical reimbursement in the group with having severe complication in primigravida vaginal delivery group and the group with having severe complication in multigravida vaginal delivery group were significantly higher in the group without complication in primigravida vaginal delivery group and the group without complication in multigravida vaginal delivery group, separately. CONCLUSION: Severity classification system-severe complication, multiple complication, moderate complication, non-complication-should be included in obstetric DRG classification system.
Cesarean Section ; Classification* ; Diagnosis ; Diagnosis-Related Groups* ; Female ; Humans ; Insurance ; Insurance, Health ; Korea ; Pregnancy

OBJECTIVES: To analyze medical service utilization and trends among the elderly in the last year of life. METHOD: The subjects of this study were people that had died at the age sixty-five and above between January 1st and June 30th 2000 The names of the deceased and their dates of death were collected from the data of the funeral-expenses-receivers of the National Health Insurance Corporation (NHIC). This data was merged with that of the individual medical expenses of the NHIC. RESULTS: In the first half of 2000, 84.2% of the funeral-expenses-receivers (53, 063) utilized medical services during the year prior to their death; 51.0% (27, 042) were female and 49.0% (26, 021) male. In the last twelve months of life, the medical fees, the number of days receiving medical services and the number of days receiving medicine were 3, 107, 935 Won, 47.88 and 153.21, respectively, for each person. As the age of the groups increased, the level of medical service utilization decreased; the change was more obvious in female group. The level of medical service utilization during the twelve months prior to death drastically increased around the time of death. CONCLUSIONS: This study, from an analysis of the level of medical service utilization prior to death, shows a concentrated volume of medical services during a certain time period prior to death.
Aged* ; Fees, Medical ; Female ; Humans ; Male ; Methods ; National Health Programs