We have attempted to measure parafoveal retinal acuity directly on the exact retinal locus, while observing the retinal image in real time using the scanning laser ophthalmoscope(SLO 101, Rodenstock, Munish, Germany). By the SLO Visumetry software(Rodenstock v. 3.0), thirty eyes of healthy volunteers were examined in 20degrees image field. Using Snellen E as stimulus, the examination was performed from the fovea by the radial pattern. The maximal retinal distance point, which responded to stimulus, was recorded by the pixel, and the distance(mm) from the fovea was calculated by the Bennett formula. The maximum distance from the fovea at the given stimulus size was achieved as follows: 0.32+/-0.01mmat the 15 x15 arc of minute(0.333), 0.63+/-0.01mm at the 17 x17 arc of minute(0.294), 1.05+/-0.03 mmat 20 x 20 arc of minute(0.25), and 1.44+/-0.0 5 mmat the 23 x23 arc of minute(0.217). It was also revealed that the horizontal maximal distance from fovea at given stimulus size was statistically superior to the vertical maximal distance(p<0.05). In conclusion we were able to establish the normal range of parafoveal retinal acuity in healthy volunteers. It may serve as the baseline for subsequent study of retinal pathology and functional evaluation as well as its treatment.
Healthy Volunteers* ; Pathology ; Reference Values ; Retinaldehyde* ; Visual Acuity*

BACKGROUND: Asthmatic patients frequently suffer cold-weather-associated respiratory symptoms. The sensitivity, specificity, accuracy and diagnostic value of isocapnic hyperventilation of cold air(IHCA) using a multistep method was investigated in patients suspected to have asthma. METHOD: One hundred and 29 adult patients who had an IHCA performed between july 1999 and December 2000, had an methacholine bronchoprovocation test because of a clinical suspicion of asthma. RESULTS: According to strict criteria, 50 were defined as asthmatics and 79 as symptomatic nonashmatics. There were no differences in age, sex and smoking state between the asthmatic and symptomatic nonasthmatic groups. There was a significant decrease in the percentage reduction in the forced expiratory volume in 1 second(FEV1) after the IHCA between the asthmatics(-10.0±6.8%) and the symptomatic nonasthmatics(-2.3±2.5%). The factors associated with a reactivity to IHCA were FEV1/FVC, FEF25-75/FVC and FEV1(% of predicted). The accuracy was highest using a 7% fall in FEV1; the sensitivity was 76% and the specificity 96%. CONCLUSION: IHCA is a specific, although not a sensitive, test for diagnosing asthma in adult patients. Furthermore, the diagnostic cut-off value of the different methods of IHCA need to be determined.
Adult* ; Asthma* ; Forced Expiratory Volume ; Humans ; Hyperventilation* ; Methacholine Chloride ; Sensitivity and Specificity ; Smoke ; Smoking

PURPOSE: To analyze the hyperacuity defects of preferential hyperacuity perimeter (PHP) in myopic CNV and correlate with the other macular anatomical or physiological properties obtained with fluorescein angiography (FA), Optical coherence Tomography (OCT), and central perimeter. METHODS: Seven patients with myopic CNV diagnosed by FA underwent PHP, OCT, central visual field (VF). We examined the locational correlation among FA, central VF and PHP hyperacuity defect and then compared PHP hyperacuity defect with the CNV size by OCT. Also we made a comparison with macular sensitivity change in VF and hyperacuity defects change in PHP after PDT in 4 patients. RESULTS: All the 7 eyes with myopic CNV tested positive for hyperacuity defects. 5 eyes showed locational correlation among PHP and FA, central VF. The size of hyperacuity defect of PHP and CNV size by OCT was positive correlation (p=0.007). Four eyes treated with PDT showed decrease of PHP hyperacuity defect size and changes in location according to decrease of CNV size after PDT. CONCLUSIONS: Our results suggest that the PHP may be used to detect myopic CNV and beneficial for analyzing functional effect following PDT in myopic CNV patients. These results require further validation in a larger population.
Fluorescein Angiography ; Humans ; Photochemotherapy ; Tomography, Optical Coherence ; Visual Fields

BACKGROUND: The past. studies on prediction formulas of pulmonary function parameters in healthy nonsmoking Korean adults have been performed in relatively small number of subjects and the reported results were restricted on a few parameters. Also there was no systematic investigation into the effect of smoking on pulmonary function parameters in smokers who have no respiratory symptoms. Therefore we attempted to establish prediction formulas of pulmonary function parameters and examined the effect of smoking on pulmonary function parameters. METHODS: We analyzed the result of parameters derived from the forced expiratory spirogram in 1,067 nonsmoking subjects from June in 1990 to December in 1991. They consisted of 306 males and 761 females and had neither respiratory symptoms nor history of respiratory disease. We derived prediction formulas by multiple linear regression method from their age, heights, and weights in each sex. To examine the effect of smoking on pulmonary function parameters, we classified 383 smoking men into three groups according to the past amount of smoking as follows : i.e. group of smokers who have smoked below 10 pack-years, 10-20 pack-years and above 20 pack-years. Regarding each group of past smoking as an independent dummy variable, we analyzed pulmonary function parameters including nonsmoking men as a baseline by multiple linear regression. We evaluated the smoking effect on pulmonary function parameters according to estimated p-value. RESULT: 1) Prediction formulas for pulmonary function parameters in each sex were derived. 2) The past smoking less than 10 pack-years does not give any effect on pulmonary function parameters. The past smoking of 10~20 pack-years showed significant negative correlation with FEV1/FVC and FEF 25~75%, and the smoking above 20 pack years showed negative correlation with FEV1 and FEV1/FVC. CONCLUSION: We have got prediction formulas of pulmonary function parameters which is driven from forced expiratory spirogram in nonsmoking Korean adults by multiple linear regression from age, heights and weights of subjects. The past smoking more than 10 pack-years showed negative correlation with some pulmonary function parameters of airflow obstruction.
Adult* ; Female ; Humans ; Linear Models ; Male ; Smoke* ; Smoking* ; Weights and Measures

PUROSE: There are numerous biopsy protocols that have been described in the clinical literature. We especially assess the role of the use of an enema before a transrectal prostate biopsy by comparing the post biopsy- infectious complications rate. MATERIALS AND METHODS: From January 2007 to August 2007 we retrospectively evaluated 302 men who underwent transrectal needle biopsy of the prostate according to the inclusion criteria. Patients in group 1(121 patients) did not receive an enema and were given oral ciprofloxacin(500 mg) for 3 days. Those in group 2(181 patients) received an enema before the biopsy and were also administered intravenous ciprofloxacin(400mg) and an additional oral form(500mg) for five days. Only complications related to infection were evaluated, that is, fever and chills with systemic inflammatory symptoms, within two weeks after the biopsy. RESULTS: Patients demographics, such as age and prostate size did not differ between the two groups(p>0.05), but the level of prostate-specific antigen (PSA) in group 2 was significantly higher than in group 1 (12.70ng/ml versus 28.88ng/ml, p<0.05). The cancer detection rate was 36.1%(109/ 302) overall and there was no significant difference between the two groups(32.2% versus 38.7%, p>0.05). The infectious complications rate was 2.6%(8/302) overall and did not differ significantly between the two groups(2.5% versus 2.8%, p>0.05). Especially for group 2 patients, there were two cases of bacteremia and Escherichia coli was reported as the pathogen. CONCLUSIONS: Our findings suggest that the use of a pre-biopsy enema shows no significant benefit given the considerations of infectious complications rate, and the patient quality of life.
Male ; Humans ; Biopsy

PURPOSE: We report a case of central retinal artery occlusion after two intravitreal injections of triamcinolone acetonide for diabetic macular edema due to non-proliferative diabetic retinopathy. METHODS: A forty-six year old man with a ten-year history of DM visited our clinic because of diminished vision in his right eye (0.02). He received intravitreal triamcinolone acetonide for diabetic macular edema due to NPDR. After injection, he showed recovery of visual acuity (0.9) and decrease of macular edema. After two months, he received a second intravitreal triamcinolone acetonide injection because his visual acuity had diminished during the two-month period. Fifteen days after the second injection, visual acuity of his right eye suddenly diminished to no light perception. At this time, we performed fundus photograph, fluorescein angiography, and optical coherence tomography. RESULTS: From the fundus exam, we diagnosed the patient with CRAO and prescribed an antithrombotic agent. Five month after the occlusion, visual acuity of the right eye improved 0.3, but generalized sclerosis of retinal vessels was present. Eight months after the occlusion, however he developed neovascular glaucoma and visual acuity of the right eye fell to the light perception negative range. CONCLUSIONS: We experienced a case of central retinal artery occlusion after intravitreal triamcinolone acetonide injection. Therefore, possible vascular complications should be considered following this type of injection.
Diabetic Retinopathy* ; Fluorescein Angiography ; Glaucoma, Neovascular ; Humans ; Intravitreal Injections ; Macular Edema* ; Retinal Artery Occlusion* ; Retinal Artery* ; Retinal Vessels ; Sclerosis ; Tomography, Optical Coherence ; Triamcinolone Acetonide* ; Triamcinolone* ; Vision, Low ; Visual Acuity

PURPOSE: It is difficult to make the standard ischemic RPE culture model which is still not established. In ischemic model, oxygen and glucose are very important. To improve experimental model, we evaluate the effect of glucose on anoxia-induced human RPE cell damage. METHODS: Human RPE cells were incubated with 95% N2/5% CO2 and standard conditions (95% air/5% CO2) at 37degrees C, and various concentation of glucose were added to a glucose-free medium : no glucose, 0.2 mg/ml, 0.4 mg/ml, -2.0 mg/ml. On a daily basis, morphological and proliferation analysis was conducted using the inverted phase contrast microscope. The extent of cell damage was estimated through cell viability analysis. Cell viability was examined using PMS(phenazinemethosulphate)-MTS(3-(4.5 -dimethyl-thiazol-2-yl)-5-(3-caboxymethoxyphenyl)-2-(4-sulfo phenyl)-2H-tetrazolium, inner salt)assay after 24, 48, 72, and 96 hours. Single-stranded DNAs were detected with monoclonal antibody to prove cell apoptosis in cell damage. RESULTS: At slightly low glucose concentration(0.4 mg/ml), the cell viability of human RPE cells cultured at room air was maintained up to 96 hours, whereas that cultured at 95% N2 decreased after 48 hours. At the anoxic condition. the cell viability of human RPE cells cultured with the low glucose concentration (0.2 mg/ml) decreased after 24 hours, but those done with higher glucose concentrations (more than 0.8 mg/ml) were maintained up to 96 hours. In the cell death caused by the anoxic culture, apoptosis was not suggested by single-stranded DNA detection. CONCLUSIONS: Properly higher glucose concentration on culture medium improve cell viability and reduce the cell damage in human RPE culture in anoxic condition. This result helps to improve experimental ischemic model of RPE cell.
Anoxia ; Apoptosis ; Cell Death ; Cell Survival ; DNA, Single-Stranded ; Glucose* ; Humans* ; Models, Theoretical ; Oxygen ; Retinaldehyde*

BACKGROUND: The purpose of this study was to report findings of exploratory arthroscopic assessment performed in conjunction with removal of internal fixation device placed in the initial surgery for rotational ankle fracture. METHODS: A total of 53 patients (33 male, 20 female) who underwent surgery for rotational ankle fracture between November 2002 and February 2008 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Lauge-Hansen classification system of ankle fractures was assessed for all patients. Intra-articular lesions (osteochondral lesion, loose body, and fibrosis) were evaluated via ankle arthroscopy. Comparative analysis was then performed between radiological classification of ankle fracture/patient's symptoms and arthroscopic findings. RESULTS: Lauge-Hansen classification system of ankle fractures included supination-external rotation type (n = 35), pronation-external rotation type (n = 9), and pronation-abduction type (n = 9). A total of 33 patients exhibited symptoms of pain or discomfort while walking whereas 20 exhibited no symptoms. Arthroscopic findings included abnormal findings around the syndesmosis area (n = 35), intra-articular fibrosis (n = 51), osteochondral lesions of the talus (n = 33), loose bodies (n = 6), synovitis (n = 13), and anterior bony impingement syndrome (n = 3). Intra-articular fibrosis was seen in 31 of symptomatic patients (93.9%). Pain or discomfort with activity caused by soft tissue impingement with meniscus-like intra-articular fibrosis were found in 19 patients. There was statistical significance (p = 0.02) between symptoms (pain and discomfort) and the findings of meniscus-like fibrosis compared to the group without any symptom. CONCLUSIONS: Arthroscopic examination combined with treatment of intra-articular fibrosis arising from ankle fracture surgery may help improve surgical outcomes.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ankle/*pathology/radiography/*surgery ; Ankle Fractures/*pathology/radiography/*surgery ; Arthralgia ; Arthroscopy/*methods ; Female ; Fibrosis ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

A 56-year old female who had an atrial septal defect with tricuspid regurgitation received a patch repair and tricuspid annuloplasty. During weaning from cardiopulmonary bypass (CPB), bright red blood filled the endotracheal tube and breathing circuit. We suctioned the blood through the endotracheal tube. The bleeding was massive (about 400 ml) but the airway could be cleared with endotracheal suction. We irrigated endotracheal tube with normal saline with phenylephrine. The weaning of CPB was done and protamine was administered. The bleeding ceased when protamine was administered. Weaning from CPB was accomplished uneventfully. We found a little bleeding in the right main stem bronchus by flexible bronchoscopy but did not do any more procedures. In the intensive care unit, the patient had stable vital signs and good respiratory function. The patient was extubated without any problems at postoperative 1 day and transferred to ward without any complications.
Bronchi ; Bronchoscopy ; Cardiopulmonary Bypass* ; Female ; Heart Septal Defects, Atrial ; Hemoptysis* ; Hemorrhage ; Humans ; Intensive Care Units ; Middle Aged ; Phenylephrine ; Respiration ; Suction ; Tricuspid Valve Insufficiency ; Vital Signs ; Weaning

Acute or chronic otitis media can cause intracranial complications, one of the most serious being brain abscess. Empirical antibiotic treatment and proper surgical management should be considered to avoid fatal consequences. However, proper extent and optimal timing of surgical intervention are still matters of debate. We present a case of a 31-year-old man who presented with acutely altered mental status, caused by otogenic brain abscess who we treated successfully with antibiotics and otologic surgery and no neurosurgical treatment.
Adult ; Anti-Bacterial Agents ; Brain Abscess* ; Humans ; Otitis Media ; Unconsciousness*