BACKGROUND: Portable devices for measuring peak expiratory flow(PEF) are now of proved value in the diagnosis and management of asthma and many lightweight PEF meters have become available. However, it is necessary to determine whether peak expiratory flow rate(PEFR) measurements measured with peak flowmeters is accurate and reproducible for clinical application. The aim of the present study is to define accuracy, agreement, and precision of mini-Wright peak flow meter(MPFM) against standard pneumotachygraph. METHODS: The lung function tests by standard pneumotachygraph and PEFR measurement by MPFM were performed in a random order for 2 hours in 22 normal and 17 asthmatic subjects and also were performed for 3 successive days in 22 normals. RESULTS: The PEFR measured with MPFM was significantly related to the PEFR and FEV1 measured with standard pneumotachygraph in normal and asthmatics(for PEFR, r=0.92 p<0.001; for FEV1, r=0.78 ; p<0.001). The accuracy of MPFM was within 10%(limits of accuracy recommeded by NAEP) in all the subjects or 22 normal, mean difference from standard pneumotachygraph being I 6.5L/min(percentage of difference being 2.90%) or 1 0.6L/min(percentage of difference being 1.75%), respectively. According to the method proposed by Bland and Altman, the 95% limits of the distribution of differences between MPFM and standard pneumotachygraph after correction of PEFR using our regression equation were +38.2 and -71.5L/min in all the subjects or -20.49~ + 9.49L/min in 22 normal and was similar to the intraindividual agreements for 3 successive days in normal. There was no statistically significant difference of PEFR measured with MPFM and standard pneumotachygraph among three days(p>0.05) and the coefficient of variation(2.4 1.2%) of PEFR measured with MPFM was significantly lower than that( 5.2 3.5%) with standard pneurnotachygraph in normal (p<0.05). CONCLUSION: This results suggest that the MPFM was as accurate and reproducible as standard pneumotachygraph for monitoring of PEFR in the asthmatic subjects.
Asthma ; Diagnosis ; Flowmeters ; Peak Expiratory Flow Rate ; Respiratory Function Tests

To compare the differences between hemodialysis and essential hypertension patients and its affecting factors of left ventricular hypertrophy and left ventricular systolic dysfucntion in patients with hemodialysis, M-mode and two dimensional echocardiography were performed in 77 essential hypertension without azotemia and 78 chronic renal failure patients receiving maintenance hemodialysis. M-mode measurement including LV mass (192.56+/-63.6g vs 300.01+/-95.99g, P=0.000), r/th (radius/LV thickness, 4.41+/-0.97 vs 4.74+/-1.0, P=0.039), LV dimemsion and fractional shortening (4.68+/-0.6 vs 5.63+/-0.97, P=0.000, 30.0+/-19.7% vs 36.6+/-97%, P=0.000 respectively) showed more severe eccentric LV hypertrophy and LV dysfunction in patients with hemodialysis than those of essential hypertension. Using Pearson correlation in hemodialysis patients, Interdialytic weight gain was positively correlated with LVEDD (r=0.318, P=0.005). In addition to the determinant, serum PTH level was negatively (r=-0.344, P=0.002) and Kt/V (r= 0.0487, P=0.003) was positively correalated with systolic function. The hypertension and dialysis duration, patient's age, had no relationship with LV function and mass in this study. In Conclusion, LV hypertrophy and LV systolic dysfunction occur more frequently in hemodialysis patients than in essential hypertension patients. And the LV systolic dysfunction, which is acutally related with the patient's quality of life, was partially explained by serum parathyroid level and Kt/V. But additional laboratory and prospective clinical studies are needed to further elucidate the mechanisms involved in the development of LVH and LV impairment in hemodialysis patients.
Azotemia ; Dialysis ; Echocardiography* ; Humans ; Hypertension* ; Hypertrophy ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic ; Quality of Life ; Renal Dialysis* ; Ventricular Dysfunction, Left ; Weight Gain

NO abstract available.
Glomerulonephritis, IGA* ; Humans ; Immunoglobulin A* ; Lymphocytes* ; RNA, Messenger* ; Transforming Growth Factor beta

Airway hyperresponsiveness is a consistent feature of asthma. Since the airway smooth muscle is hyperresponsive to a number of different stimuli operating through many different mechanisms, it is attractive to speculate that the abnormality may reside in the airway smooth muscle itself. Animal model of asthma is needed to unravel possible mechanisms underlying airway hyperresponsiveness and also to develop new therapeutic approaches. However, there are few reports showing that airway smooth muscle from animal asthma model is indeed hyperresponsive. In addition, sensitizing and provoking doses of allergen were different each other ambng the studies on animal asthma model. The aim of this study was to determine an appropriate sensitizing and provoking dose of allergen to induce a maximum airway hyperresponsiveness. Eighty-four male Sprague-Dawley rats were actively sensitized with a subcutaneous injection of 0, 10, or 1000/gg ovalbumin(OA) and 14 days later they were provoked with 0, 1, or 5 % OA aerosols. One day after the provocation, serum levels of OA-specific IgE, cell numbers in bronchoalveolar lavage fluid (BALF), and in vitro isometric contractile responses of the isolated tracheal smooth muscle(TSM) to 120 mM KC1, acetylcholine(ACh, 0.1~ 1000/micro meter), electrical field stimulation (EFS, 0.5~100Hz), serotonin(5-HT, 0.014 100/micro meter), and OA(10, 50, or 250 micro gram/ml) were measured. The results were as follows; 1) When 38 OA-sensitized rats were exposed to OA aerosols in vivo early asthmatic responses(EAR) were observed in 20(52.6%) rats. In vitro isometric contractile forces of TSM from rats with EAR were stronger than those from rats without EAR. 2) The maximal contractile responses to KC1 and EFS were significantly higher in rats only sensitized with OA compared with those in controls. The maximal response to ACh was significantly related to OA-specific serum IgE level(r=0.40, p%0.05), and the latter was in turn significantly related to the BALF eosinophil count(r=0.67, p<0.01). 3) When 10 microgram OA-sensitized rats were analyzed, the maximal response to KC1, ACh, EFS, and 250 micro gram/ml OA were lower in OA-provoked rats compared to those in saline-provoked control rats, in which 5% OA-provoked rats had a lower response than 1% OA-provoked rats. 4) The sensitivity of TSM to ACh was significantly higher in 10/micro gram OA-sensitized & OA-provoked rats, and the sensitivity to EFS was also significantly higher in 10/~g OA-sensitized & 5% OA-provoked rats compared to that in controls(p<0.05). 5) There was a significant correlation between the sensitivity of TSM to EFS and the counts of eosinophil or of lymphocytes in BALF(for eosinophil, r=-0.30; p<0.05, for lymphocyte, r=-0.35; p<0.05), or OA-specific serum IgE level(r=-0.46, p<0.01) in OA-sensitized & OA-provoked rats. This relationship was maintained in the data obtained only from 10 micro gram OA-sensitized & 5% OA-provoked rats. 6) The ratio of EFS-sensitivity to ACh-sensitivity was significantly lower in OA-sensitized & OA-provoked rats compared to that in controls or rats only sensitized with OA(p%0.05). 7) The Schultz-Dale phenomenon occurred in an in vitro dose-dependent manner. However, the inhaled provocation with OA in vivo resulted in a decrease in the contractile response to OA in vitro. There was a significant correlation between OA-specific serum IgE level and isometric response to 250 micro gram/ml OA(r=0.36, p<0.01). These results suggest that sensitization and provocation in vivo with OA in rats induces hypersensitivity of airway smooth muscle to cholinergic stimuli through an allergic inflammatory mechanism. The sensitivity was highest when sensitized to 10 micro gram OA and exposed to 5% OA aerosols.
Aerosols ; Animals ; Asthma* ; Bronchoalveolar Lavage Fluid ; Cell Count ; Ear ; Eosinophils ; Humans ; Hypersensitivity ; Immunoglobulin E ; Injections, Subcutaneous ; Lymphocytes ; Male ; Models, Animal ; Muscle, Smooth* ; Rats* ; Rats, Sprague-Dawley

Dural arteriovenous fistula (DAVF) of anterior cranial fossa is a rare entity. The authors report a 57 year-old man presented with retro-orbital headache caused by a large hematoma in the right frontal lobe. Angiography demonstrated a DAVF of anterior cranial fossa fed by branches of middle meningeal and anterior ethmoidal artery. Endovascular therapy using N-butyl cyanoacrylate was tried, however, was failed to occlude the fistula. After than, the lesion was successfully obliterated by surgical means. The therapeutic roles and pitfalls of endovascular treatment and surgical treatment for the anterior fossa DAVF are discussed.
Angiography ; Arteries ; Central Nervous System Vascular Malformations* ; Cranial Fossa, Anterior* ; Cyanoacrylates ; Fistula ; Frontal Lobe ; Headache ; Hematoma ; Humans ; Middle Aged

BACKGROUND: Microalbuminuraia is a strong prognostic factor for cardiovascular morbidity and mortality in type I and II diabetics. Recent data suggest that microalbuminuria predicted cardiovascular disease independent of hypertension in one of two large-scale studies performed in non-diabetics. Additional possibilities could be a previously documented association with other major and interconnected cardiovascular risk factors, such as insulin resistance, and elevated cardiac mass, abnormal circulation lipid levels, and overweight. The object of this study os to investigat the incidence of microalbuminuria, and to define the pathophysiologic mechanism of microalbuminuria to contribute coronary heart disease in non-diabetic patients with angiographiclly documented coronary artery disease(CAD). METHODS: The study group comprised 31 patients(M;21, mean age 60+/-30 year) with angiographically documented CAD and 15 normal control(m;9, mean age 62+/-7 year). Urinary albumin excretion, blood pressure, echocardiographic left ventricular mass indes, plasma abdominal/hip circumference ratio, fasting glucose, insulin, and c-peptide were studied. The microalbuminuria was defined urinary albumin more than 20ug/min. RESULTS: 1) Six of 31 patients with CAD(19.4%) and none of 15 normal control had microalbuminuria. Hypertension were documented 13 of 31 patients with CAD, and none of 15 normal control(p<0.01). Five of 6 patients with CAD and microalbuminuria and 8 of 25 patients with non-microalbuminuric aptients had hypertension (p<0.05). 2) In the microalbuminuric subjects with CAD, body mass index(29.0+/-3.2vs 24.8+/-3.5), systolic blood pressure(138+/-31 vs 118+/-15mmHG), lipoprotein(a) (69+/-31vs 32+/-32mg/dl), fastion C-peptide(5.5+/-2.2 vs 2.7+/-1.6ng/ml), and microalbumin(221+/25 vs 9.6+/-7.9mg/day)were significantly greater than in normal control(p<0.05). But no difference in left ventricular mass, lipid profile, and abdominal/hip circumference ratio existed between the microalbminuric patients with CAD and normal control. 3) Between the microalbuminuric patients with CAD and without CAD, no signficant difference were noted excepr lipoprotein(a) lever(69+/-31 vs 29+/-29mg/dl), fasting C-peptide(5.5+/-2.4 vs 2.5+/-1.2ng/ml), and microalbumin(221+/-247 vs 8.6+/-6.7mg/day). CONCLUSION: Microalbuminuria was associated with history of hypertension or concurrent antihypertension therapy and insulin resistance in non-diabetics with CAD. But left ventricular cardiac mass, central obesity inedw, and lipid profile were not related with microalbuminuria. The underlying presence of a major risk factor such as hypertension and insulin resistance might be explain the previously reported predictive value of microalbuminuria for cardiac events.
Blood Pressure ; C-Peptide ; Cardiovascular Diseases ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Echocardiography ; Fasting ; Glucose ; Humans ; Hypertension ; Incidence ; Insulin ; Insulin Resistance ; Lipoprotein(a) ; Mortality ; Obesity, Abdominal ; Overweight ; Plasma ; Risk Factors

Background: This study described the surgical technique of a robot-assisted retroauricular anterior scalenectomy and assessed clinical outcomes and complications for patients with neurogenic thoracic outlet syndrome (nTOS). Methods: Between February 2014 and August 2016, 5 patients underwent robot-assisted retroauricular anterior scalenectomy using the da Vinci Xi system for nTOS. For clinical assessment, visual analog scale (VAS) symptom score, pinch and grip strength, and disabilities of arm, shoulder and hand (DASH) score were assessed to compare preoperative and postoperative outcomes. Postoperative complications were also reviewed. Results: The VAS symptom, pinch and grip strength, and DASH scores improved 1 year after the operation. All patients were satisfied with the surgical scars. Temporary postoperative complications, which spontaneously resolved within 3 months, were noticed in 2 patients: one with vocal cord palsy and the other with upper brachial plexus palsy. Conclusions The robot-assisted retroauricular anterior scalenectomy for patients with nTOS seems feasible and safe, providing satisfactory cosmetic results.

BACKGROUND: It has been suggested that the incidence of tourniquet pain is less frequent in patients in whom bupivacaine has been employed for spinal anesthesia than in patients to whom tetracaine has been administrated. The current study was accomplished to compare the incidence of tourniquet pain in patients in whom 0.5% plain bupivacaine spinal anesthesia and 0.5% hyperbaric tetracaine spinal anesthesia were employed. METHODS: The incidence of tourniquet pain was evaluated in 40 patients having orthopaedic surgery of the lower extremities during spinal anesthesia using 15 mg of hyperbaric 0.5% tetracaine(group I) or 15 mg of a plain solution of 0.5% bupivacaine(group II). The drugs were administrated in a randomized fashion. We measured the maximal sensory spread of analgesia to pinprick test, the incidence of tourniquet pain, the sensory anesthesia to pinprick test at time of onset of tourniquet pain and the number of patient treated with IV injection of fentanyl to relieving tourniquet pain. RESULTS: The maximal sensory spread of analgesia mean was higher in patients given hyperbaric tetracaine (T8) than in patients given plain bupivacaine (T9). The incidence of tourniquet pain was significantly greater in patients given hyperbaric tetracaine (65%) than in patients given plain bupivacaine (15%). The incidence of analgesics injection for tourniquet pain was greater in patients given hyperbaric tetracaine (10%) than in patients given plain bupivacaine (none). CONCLUSIONS: In conclusion, the tourniquet pain in surgery of the lower extremities occurs less frequently when plain bupivacaine is employed for spinal anesthesia as compared to hyperbaric tetracaine.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia, Spinal* ; Anesthetics ; Bupivacaine ; Fentanyl ; Humans ; Incidence ; Lower Extremity ; Tetracaine ; Tourniquets*

The natural course of lateral epicondylitis is widely regarded to be self-limiting within 1 year of symptom duration in 90% of all patients. The spectrum of treatments include simple ‘wait and see', bracing, physical therapy, corticosteroid injection, and recently some biologic injection such as autologous blood and platelet rich plasma. However, recalcitrant lateral epicondylitis which are not responding to conservative treatments can be treated with surgical treatment although much remains unclear regarding the ideal treatment. Debates surrounding open procedures are the management for the defect after resection of pathologic tissue, necessity of decortication, selective denervation procedure, etc. Since the trend is changing to minimal invasive surgery and arthroscopic release of extensor carpi radialis brevis tendon are becoming more popular these days, surgical tips and pitfall to obtain good results and avoid complications have been reported recently. Bipolar radiofrequency (RF)-based microtenotomy or percutaneous tendon release is another surgical procedures reported to be effective in lateral epicondylitis. However, there are some patients who present with persistent pain after surgical treatment. Thus, selection of ideal candidates for surgery, thorough evaluation of all pathologies prior to surgery, and adequate surgical procedures would be essential in the surgical treatment of lateral epicondylitis.
Braces ; Denervation ; Humans ; Pathology ; Platelet-Rich Plasma ; Tendons ; Tennis Elbow ; Tenotomy

A 49-year-old man with an uncorrected visual acuity (UCVA) of 20 / 1000, a best spectacle-corrected visual acuity (BSCVA) of 20 / 400, keratometric readings of K1 = 59.88 x 82degrees / K2 = 45.88 x 172degrees, and an inferior steepening that was consistent with keratoconus in his left eye was treated with clear-cornea phacoemulsification and an intraocular lens (IOL) implantation after insertion of keraring intrastromal corneal ring segments for severe keratoconus and cataract. An asymmetrical pair of kerarings was implanted with the assistance of a femtosecond laser in September 2008; the one segment was 250 microm and the other was 150 microm and both were placed at 70degrees. Three months after the kerarings were implanted, clear-cornea phacoemulsification and IOL implantation were performed on the left eye. After surgery, both the UCVA and the BSCVA of the left eye improved by eight lines. Postoperative central keratometry showed a decrease of 7.35 diopters in the left eye. Both the postoperative refraction (-0.75 -0.75 x 60degrees) and the keratometric reading (K1 = 50.05 x 93degrees / K2 = 48.83 x 3degrees) remained stable one month following the procedures. Thus, the sequential order of intrastromal corneal rings implantation and cataract surgery can be considered as a treatment option in patients with severe keratoconus and cataract.
Cataract/*complications/diagnosis ; Corneal Stroma/pathology/*surgery ; Corneal Topography ; Follow-Up Studies ; Humans ; Keratoconus/complications/diagnosis/*surgery ; Lens Implantation, Intraocular/*methods ; Male ; Middle Aged ; Phacoemulsification/*methods ; Severity of Illness Index