PURPOSE: To evaluate the usefulness of automated measurements of the localized retinal nerve fiber layer (RNFL) defects area in patients with glaucoma. METHODS: Fifty one patients with localized RNFL defects in RNFL red-free photographs and 53 healthy subjects were included. All participants were imaged with 3D spectral-domain optical coherence tomography (OCT). The area of defects was measured with the RNFL significance map (red = p < 1% and yellow = p < 5%) using Image J manually and Matlab software automatically. The area under the receiver operating characteristic curve (AUC) was calculated for the RNFL defect area of the RNFL photograph and RNFL maps, circumpapillary RNFL thickness, optic disc parameter, and macular inner retina thickness. RESULTS: High correlation was observed between manually and automatically measured defect areas in the significance map (red area r = 0.904, red and yellow area r = 0.890). The AUC for manually and automatically measured defects area (0.987, 0.966; p < 5%, p = 0.31, respectively) in the significance map was comparable. The latter demonstrated slightly higher but insignificant difference in AUC for inferior quadrant circumpapillary RNFL thickness (0.936; p = 0.22) and was significantly higher than the inferior ganglion cell layer plus inner plexiform layer thickness (0.894) and vertical cup to disc ratio (0.869) (p = 0.018, p = 0.008, respectively). CONCLUSIONS: The automated measurements of the RNFL defect area in the significance map performed adequately in detecting localized RNFL defects and had a better performance than macular inner retina and optic nerve parameters.
Area Under Curve ; Ganglion Cysts ; Glaucoma ; Humans ; Nerve Fibers ; Optic Nerve ; Retina ; Retinaldehyde ; ROC Curve ; Tomography, Optical Coherence

BACKGROUND: Spinal anesthesia is a simple technique requiring a small dose of local anesthetic to provide intense and reliable block. And epidural anesthesia with the catheter technique gives a better control of the level of analgesia and a good postoperative pain relief using opioids, local anestheties or both. Therefore, the combined spinal epidural (CSE) anesthesia was evaluated to provide rapid onse of action, good muscle relaxation, prolonged duration of the block and postoperative pain relief. METHODS: All patients were placed in a lateral position. Using a midline approach at L interspace, a 18G Tuohy needle was introduced into the epidural space. A 27G Whitacre spinal needle was passed through the Tuohy needle until free flow cerebrospinal fluid, and than 0.5% heavy bupivacaine 3ml(15mg) was injected. The spinal needle was withdrawn and the epidural catheter was inserted. The dermatome level and time of sensory block was evaluated using loss of sensation of pinprick test every 1 minute for 30 minutes, until the maximum sensory block was established. Motor block was assessed using the Bromage scale. And postoperatively we interviewed the patients for opinioes on the blockade and complication. RESULTS: The mean values of maximum sensory block level were T8 (T8.0+/-1.7 dermatome) and at that time was 8min 30sec (8.5+/-1.2min). The motor blockade of lower extremity was Bromage 3 in all patients. Prolonged anesthesia over 2 hours of operation was accomplished by adding 0.5% bupivacaine through epidural catheter. Subjective evaluation by the patients about postoperative pain control was excellent. CONCLUSIONS: CSE anesthesia appears to combine the reliabiIity and rapid onset of spinal block, and the ability to extend the block and postoperative analgesia by using the epidural catheter while minimizing their drawbacks.
Analgesia ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Epidural* ; Anesthesia, Spinal ; Bupivacaine ; Catheters ; Cerebrospinal Fluid ; Epidural Space ; Humans ; Lower Extremity* ; Muscle Relaxation ; Needles ; Pain, Postoperative ; Sensation

BACKGROUND: Surgical trauma is a potent stimulus for the neurohormonal axis. The catecholamine response to surgical stress may be modulated by the anesthetic regimen utilized. We compared the hemodynamic response and catecholamine concentration to lower abdominal surgery during anesthesia with propofol or enflurane. METHODS: Forty six patients undergoing lower abdominal surgery were assigned randomly to two groups. In group I, anesthesia was induced with thiopental sodium 5.0mg/kg and maintained with enflurane-N2O. In group II, anesthesia was induced with propofol 2.0mg/kg and maintained with propofol 12 mg/kg/min by infusion pump. Hemodynamic responeses were recorded at tracheal intubation. Blood samples for later determination of plasma catecholamine were drawn and hemodynamic responses were recorded at preinduction, 1 minute after skin incision, 30minutes after skin incision. RESULTS: There was no statistical significance in systolic and diastolic pressure between two groups. There was statistical significance in heart rate 30minutes after skin incision between two groups. There was no statistical significance in epineprine concentration between two groups. There was statistical significance in norepineprine 30 minutes after skin incision between two groups. CONCLUSIONS: Propofol may be useful alternative at lower abdominal surgery and it may be convenient and safe intravenous anesthetics.
Anesthesia* ; Anesthetics ; Anesthetics, Intravenous ; Axis, Cervical Vertebra ; Blood Pressure ; Enflurane* ; Epinephrine ; Heart Rate ; Hemodynamics ; Humans ; Infusion Pumps ; Intubation ; Plasma ; Propofol* ; Skin ; Thiopental

Cerebral air embolism is a rare but fatal complication of central venous catheterization. Here, we report a case of paradoxical cerebral air embolism associated with central venous catheterization. An 85-yr-old man underwent right internal jugular vein catheterization, and became obtunded. Brain MR imaging and CT revealed acute infarction with multiple air bubbles on the side of catheter insertion. The possibility of cerebral air embolism should be considered in patients developing neurological impairment after central venous catheterization, and efforts should be made to limit cerebral damage.
Aged, 80 and over ; Brain/pathology ; Catheterization, Central Venous/*adverse effects ; Echocardiography, Transesophageal ; Embolism, Air/*etiology/ultrasonography ; Embolism, Paradoxical/*etiology/ultrasonography ; Humans ; Intracranial Embolism/*etiology/ultrasonography ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed

Isolated sphenoid sinusitis is a rare disorder. There are some difficulties in its diagnosis; therefore the first presentation of this disorder might be with complications. These complications are essentially due to the anatomical location of the sinus and its proximity to the intra-cranial and orbital contents, to which infection may easily spread. A case of isolated sphenoid fungal sinusitis with unilateral abducent nerve palsy is being reported which was successfully treated by parenteral antibiotic therapy and endonasal endoscopic sphenoidotomy.
Abducens Nerve Diseases* ; Abducens Nerve* ; Diagnosis ; Orbit ; Paralysis ; Sinusitis* ; Sphenoid Sinus ; Sphenoid Sinusitis

STUDY DESIGN: This was a retrospective cohort study. PURPOSE: We evaluated the predictive value of the Spinal Instability Neoplastic Score (SINS) system for spinal adverse events (SAEs) in patients with single spinal metastatic tumor. OVERVIEW OF LITERATURE: The SINS system was developed to assess spinal instability in patients with single metastatic spinal tumor. However, the system’s potential predictive value for SAEs has been partially studied. METHODS: This system was applied to a retrospective cohort of 78 patients with single spinal metastatic tumors. The patients underwent surgical treatment and were postoperatively followed up for at least 2 years or until death. The attribution of each score and total SINS to SAE (vertebral compression fracture [VCF] and spinal cord compression [SCC]) occurrence was assessed using the Cox proportional hazards model. RESULTS: SAEs occurred on average 7 months after diagnosis of spinal metastasis. The mean survival rate post diagnosis was 43 months. Multivariate analysis using the Cox proportional hazards model revealed that the pain (p=0.029) and spinal alignment (p=0.001) scores were significantly related to VCF occurrence, whereas the pain (p=0.008) and posterolateral involvement (p=0.009) scores were related to SCC occurrence. CONCLUSIONS: Among the components of the SINS system, while pain and spinal alignment showed a significant association with VCF occurrence, pain and posterolateral involvement showed association with SCC occurrence.
Cohort Studies ; Diagnosis ; Fractures, Compression ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Spinal Cord Compression ; Survival Rate

Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive malformation syndrome caused by a defect in cholesterol biosynthesis. The incidence is very low in Asians and only one case has been reported in Korea thus far. Recently, we found an infant with neonatal cholestasis. He had microcephaly, ambiguous genitalia, cleft palate, syndactyly of toes, patent ductus arteriosus and hypertrophic pyloric stenosis. The serum cholesterol was decreased and serum 7-dehydrocholesterol was markedly elevated. Genetic analysis of the DHCR7 gene identified a novel missense mutation (Pro227Ser) as well as a known mutation (Gly303Arg) previously identified in a Japanese patient with SLOS. Although rare in Korea, SLOS should be considered in the differential diagnosis of neonatal cholestasis, especially in patients with multiple congenital anomalies and low serum cholesterol levels.
Amino Acid Substitution ; Base Sequence ; Cholestasis/*diagnosis ; Ductus Arteriosus, Patent/diagnosis ; Electroencephalography ; Humans ; Infant, Newborn ; Liver/pathology/ultrasonography ; Male ; *Mutation, Missense ; Oxidoreductases Acting on CH-CH Group Donors/*genetics ; Phenotype ; Smith-Lemli-Opitz Syndrome/diagnosis/*genetics

The prognosis of ovarian cancer remains poor, and there is a need to identifiy patients who are less likely to respond to treatment, in the hope that the identification of these patients with a poorer prognosis may allow the administration of more intensive or different treatment. But, most clinical and pathological factors were considered to lack satisfactory predictive power. Recently, essential role of protease in tumor cell invasion and metastasis have been elucidated in tumor biology. Urokinase-type plasminogen activator (uPA) and its inhibitor, plasminogen activator inhibitor-1 (PAI-1), play a key role in tumor-associated proteolysis. Thus, the presence of both uPA and PAI-1 modulates the invasive and metastatic phenotype of cancer cells. Genetically, nm23 protein from chromosome 17q may act independently as a metastasis suppressor. The purpose of this study was to determine the relative predictive power of some of those prognostic variables such as uPA, PAI-1 and nm23 protein in a selected group of patients of ovarian cancer. Immunohistochemical staining was used to determine the overexpression of uPA, PAI-1 and nm23 protein. Specimens were rated positive and negative. Then, scored '1' in case of positive for uPA, PAI-1, and negative for nm23, and '0' in case of negative for uPA, PAI-1, and positive for nm23, respectively. The sum of scores were divided into three groups (I, II and III groups), and compared with clinico-pathologic parameters, clinical response, lymph node metastasis, recurrence and 5-year survival rate, retrospectively. In univariate analysis, the positive rate of uPA was 36% (29/80), that of PAI-1 was 35% (28/80), and the negative rate of nm23 was 43% (34/80). The overexpression of uPA was higher in the low-grade tumor (p=0.0053), the overexpression of PAI-1 was positively correlated with the advanced stage of tumor (p=0.0001), more malignant histologic type (serous) of tumor (p=0.0013) and larger residual tumor mass (>2 cm)(p=0.0480). The overexpression of nm23 protein was negatively correlated with advanced stage of tumor (p=0.0068) and low-grade tumor (p=0.011). In scoring system, the number of patients with first group (I: score 0) was 24, II group (score: 1~2) was 49, and III group (score: 3) was 7. The mean age of patients was 46.4 years and mean follow-up time was 59 months. The rate of lymph node metastasis were 16.7%, 37%, and 75% respectively(p=0.0632). With increasing score in each group, the less clinical response rate was found (75% vs 71% vs 29%, p=0.0532). The 5-year survival rate of each group were 70% in I group, 65% in II group, and 14% in III group(p=0.0096). In conclusion, the scoring system using immunohistochemical staining with rating of overexpression uPA, PAI-1 and nm23 protein may be useful as an important and powerful predictive prognostic indicator in patients with epithelial ovarian cancer.
Biology ; Follow-Up Studies ; Hope ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm, Residual ; Ovarian Neoplasms* ; Phenotype ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators* ; Plasminogen* ; Prognosis ; Proteolysis ; Recurrence ; Retrospective Studies ; Survival Rate ; Urokinase-Type Plasminogen Activator

The prognosis of ovarian cancer remains poor, and there is a need to identifiy patients who are less likely to respond to treatment, in the hope that the identification of these patients with a poorer prognosis may allow the administration of more intensive or different treatment. But, most clinical and pathological factors were considered to lack satisfactory predictive power. Recently, essential role of protease in tumor cell invasion and metastasis have been elucidated in tumor biology. Urokinase-type plasminogen activator (uPA) and its inhibitor, plasminogen activator inhibitor-1 (PAI-1), play a key role in tumor-associated proteolysis. Thus, the presence of both uPA and PAI-1 modulates the invasive and metastatic phenotype of cancer cells. Genetically, nm23 protein from chromosome 17q may act independently as a metastasis suppressor. The purpose of this study was to determine the relative predictive power of some of those prognostic variables such as uPA, PAI-1 and nm23 protein in a selected group of patients of ovarian cancer. Immunohistochemical staining was used to determine the overexpression of uPA, PAI-1 and nm23 protein. Specimens were rated positive and negative. Then, scored '1' in case of positive for uPA, PAI-1, and negative for nm23, and '0' in case of negative for uPA, PAI-1, and positive for nm23, respectively. The sum of scores were divided into three groups (I, II and III groups), and compared with clinico-pathologic parameters, clinical response, lymph node metastasis, recurrence and 5-year survival rate, retrospectively. In univariate analysis, the positive rate of uPA was 36% (29/80), that of PAI-1 was 35% (28/80), and the negative rate of nm23 was 43% (34/80). The overexpression of uPA was higher in the low-grade tumor (p=0.0053), the overexpression of PAI-1 was positively correlated with the advanced stage of tumor (p=0.0001), more malignant histologic type (serous) of tumor (p=0.0013) and larger residual tumor mass (>2 cm)(p=0.0480). The overexpression of nm23 protein was negatively correlated with advanced stage of tumor (p=0.0068) and low-grade tumor (p=0.011). In scoring system, the number of patients with first group (I: score 0) was 24, II group (score: 1~2) was 49, and III group (score: 3) was 7. The mean age of patients was 46.4 years and mean follow-up time was 59 months. The rate of lymph node metastasis were 16.7%, 37%, and 75% respectively(p=0.0632). With increasing score in each group, the less clinical response rate was found (75% vs 71% vs 29%, p=0.0532). The 5-year survival rate of each group were 70% in I group, 65% in II group, and 14% in III group(p=0.0096). In conclusion, the scoring system using immunohistochemical staining with rating of overexpression uPA, PAI-1 and nm23 protein may be useful as an important and powerful predictive prognostic indicator in patients with epithelial ovarian cancer.
Biology ; Follow-Up Studies ; Hope ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm, Residual ; Ovarian Neoplasms* ; Phenotype ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators* ; Plasminogen* ; Prognosis ; Proteolysis ; Recurrence ; Retrospective Studies ; Survival Rate ; Urokinase-Type Plasminogen Activator

BACKGROUND AND OBJECTIVES: This study investigates the effect of patient controlled analgesia (PCA) on post-tonsillectomy pain for the first two weeks of operation, and its effects on the postoperative bleeding and the pain duration. SUBJECTS AND METHOD: In a prospective group study, 43 patients with tonsillectomy were studied. PCA was applied for 48 hours after surgery. Pain scores, postoperative bleeding, and pain duration were compared. RESULTS: PCA reduced postoperative pain during the time it was appled but pain was worse after disconnection. There were no differences between the groups regarding postoperative bleeding and recovery time. CONCLUSION: PCA could effectively control the post-tonsillectomy pain only during its application period. It was not helpful for long term pain control, pain duration, or post-tonsillectomy bleeding. Other long lasting and effective pain control method should be administered to reduce post-tonsillectomy pain during the recovery period.
Analgesia, Patient-Controlled ; Hemorrhage ; Humans ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Prospective Studies ; Tonsillectomy*